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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH
Monitoring Quality of Care
2.1 Public and private purchasers, consumers, providers, practitioners, behavioral health care plans, and accreditation organizations should continue to monitor and assess the quality of care in the following ways:
2.1.1 Quality improvement should be a priority, and principles and methods of improving quality should be adopted.
2.1.2 Accreditation and review processes must be reliable and valid and must be continuously reviewed and improved.
2.1.3 Domains relevant to the effective treatment and prevention of behavioral health problems must be emphasized in accreditation processes. These include practitioner training, consumer education, improvements in consumer self-care, and the presence of a continuum of services, including wraparound services such as housing assistance, child care, and transportation.
2.1.4 Accreditation processes must focus on areas of managed care in which there may be a risk of quality problems: (1) variability in utilization review; (2) inconsistent or inappropriate precertification processes; (3) vulnerable groups and those who are unfamiliar with managed care processes; and (4) conditions that occur frequently and are treated by many practitioners, giving opportunities for variation in treatment practices.
2.1.5 Performance measures must be relevant to treatment processes and outcomes.
2.1.6 Data must have demonstrable integrity. External, independent audits can help to validate data quality.
2.1.7 Stakeholder consensus and consumer satisfaction measures must be included in the tools used to monitor quality of care.
2.1.8 Outcomes measures should increasingly be based on evidence from research.
2.2 Quality of care should be clearly addressed in contracts between purchasers and providers.
2.2.1 When plans contract or subcontract for the management and delivery of behavioral health care services (e.g., health maintenance organizations contracting with carved-out managed behavioral health care firms), purchasers can benefit from independent audits of the contractor regarding the level of adherence to prespecified standards of performance with respect to quality.
2.2.2 Purchasers can benefit from carefully constructed contract lan