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Introduction
In the united state cost of behavioral health care has continued to rise at higher rate than that of the rest of the health care sector. This research paper explores on the efforts established to contain the rising costs of psychiatric and substance abuse care and different strategies put in place to reduce use of expensive hospital resources. Strategies that focus on management of health centers episodes case by case fall under the rubric of managed care. Managed care plans are a type of health insurance that contract between the health care providers and medical facilities to provide care to the members at a low cost. Many types of managed care plans in existence include: Health Maintenance Organization, Exclusive Provider Organization and Preferred Provider Organization (Azeni, 2014). There are a wide range of initiatives being implemented by federal and state government to enhance coordination and integrate care beyond the traditional managed care. These initiatives pay specific focus on improving care for the people with chronic and complex conditions, building in accountability for high quality care and aligning payment incentives.
In recent past, managed care companies has increasingly played an important role in behavioral health services and thus had the greatest impact in the sector. The behavioral health Medicaid managed care transition has facilitated a fully integrated behavioral health and physical health services system. It includes the development of specialized health and recovery plans for individuals with significant behavioral health needs. In this research paper particular attention is given to the behavioral health services and therefore the main objectives of the research is to differentiate between the behavioral healths services with the rest of the health care industries, indentify the professionalism of behavioral health service providers given the current scenario in the industry. It also examines the various challenges since establishment of medical care programs in the business of health services.
Present day health care scenario behavioral health services are provided the several different professionals, each of which has its own training and areas of expertise therefore the behavioral health services are profession in academic point of view. Types of professionals, as highlighted by (Dickey, 2013), who provide behavioral health services include but not limited to the following:
Just like other professional in the health care industry, behavioral health services are governed by some set professional ethics they use when providing the services.
Behavioral health care is highly affected by reimbursement barriers especially for persons with public insurance who falls in the primary care settings for the health. Such barriers include but not limited to the following:
In order to problem of reimbursement several factors need to be considered so as to achieve effective reimbursement of behavioral health care and streamline the funding system with the rest health care sectors. (Mauch, 2008) suggeted a number of actions which include
Implementation of above practical and largely achievable suggestion will help in improvement in access to timely behavioral health services especially in primary settings. Such mechanisms will improve the reimbursement of behavioral health services in primary care settings.
The most unusual aspect of the care and system of finance for behavioral health care is the presence of different and substantial publicly managed care system that serves as a safety net thus public services are for those with public insurance as well as for those who have private insurance thou under special circumstances. Public services are financed though a number of programs in different categories as administered by different agencies therefore creating duplication and gaps in the service. Such programs always have different eligibility requirement. In addition, financing is fragmented therefore leading to fragmented service delivery (Azeni, 2014).
Another challenge is that much behavioral health is provided in primary care settings other than in specialty program as opposed by clinical practice guidelines. A significant portion of the public care system for individuals with the most disabling conditions extend beyond health care services to rehabilitative and support services such as, job counseling among other programs (Johnson, 2005). In order to coordinate these services there is need for a collaborative and cooperative relationship among various agencies such as social services, behavioral health, and criminal justice among others. Most of these services are not covered by private insurance and have not been established by many behavioral health care businesses.
To date closest providers have gotten to implement the integrations suggestion often known as “treat and refer strategy” this is a strategy whereby separate primary care and mental health providers agreed to refer some cases to each other. But according to the recent strategies it has been noted that this strategy is informal and ineffective. Other strategy being implemented is bidirectional integration where behavioral health services are placed in the same physical quarters as primary care practice but both operate as separate entities with unconditioned and incompatible billing and payments systems. Unfortunately, this strategy hasn’t proven to be sustainable since they are funded by grants (Mauch, 2008).
Funding in the behavior health sector have posed a complex and ongoing challenge for program administrators because each funding stream has its own eligibility rules, reporting requirements and service conditions which often differ from those of other agencies supporting the programs operations. The disparate mandates of these funders have exacerbated system and fragmentation of the service.
Residential care may include long term care provided in a rest home or hospital such as rest home care, continuing care, dementia care as well as psycho geriatric care but these does not include independent living in a retirement village. A short term care facility provides respite care and convalescent care (Baldessarini, 2002). Under managed care residential treatment care can be more effective this is because despite the efficacy of rehabilitation centers being questioned recent studies has shown that various initiatives have positive results for example the community based residential treatment have helped in treatment of persons with behavioral needs and actually it have had long term positive impact.
An effective residential treatment or rather for residential treatments to be more effective they need to incorporate programs that are more effective. (Levins, 2014) found that the facilities with more successful results tend to have some factors that promote the effectiveness in them:
Conclusion
Managed care is an organized system of care that makes efforts to try balance access, quality and cost effective health care services. This can be made possible through use of utilization management, intensive case management, and adoption of cost containment strategies and last but not the least through provider selection. Despite the antipathy felt by most public sector health care providers towards managed care, they should strive towards the same end by using similar means as managed care organizations. Almost all the states are in the process of adopting some form of managed care to provide behavioral health care services while the federal governments consider giving waivers to implement the Medicaid managed behavioral health programs. According to (Dickey, 2013) in order to adapt to the world of managed care, treatment programs should evaluate how their services are being delivered and identify which elements should be preserved and which ones that need modifications. When doing these they should be well versed with how changes in the federal and state reforms will impact their current and future funding mechanisms.
To solve the problem of exacerbated system and service fragmentation, (Johnson, 2005) suggest that means and strategies should be developed and implemented so as to ensure integration of funding streams. This is important in order to meld services and ensure continuity of the care. Lastly although residential treatments are crucial element in the spectrum of care especially to people with behavioral needs, it’s important to consider the community based programs in order to enhance their effectiveness. Such programs should pay particular focus on personalized treatment planning, discharge planning, intensively involving the family and at least reintegration back to the community.
Azeni, H. (2014, September 24). Managed Care . Retrieved February 6, 2015, from Medline Plus: http://www.nlm.nih.gov/medlineplus/managedcare.html
Baldessarini, R. (2002). American biology psychiatrly and psycho-phamacology. Washington: American psychiatry press.
Dickey, B. (2013). Behavioral Health Professionals. Journal of Behavior Science , 120-125.
Johnson, S. (2005, August 17). Case Management In a Managed Care Environment. Retrieved February 6, 2015, from National Centre for Biotechnolgy Information: http://www.ncbi.nlm.nih.gov/
Levins, H. (2014, February 7). Perspective on Residential and Community Based Treatment . Retrieved February 6, 2015, from Magellan Health Services: http://www.magellanhealth.com/media/876271/childrens_residential_white_paper_2008.pdf
Mauch, D. (2008, February 8). Reimbursement of Mental Health Services . Retrieved February 6, 2015, from U.S. Department of Health and Human services: http://www.integration.samhsa.gov/Reimbursement_of_Mental_Health_Services_in_Primary_Care_Settings.pdf