One study states, “Mental health has proved especially vulnerable to the ravages of managed care because its patients tend not to be assertive about their right to treatment and because the subjective nature of emotional distress makes it easier to deny or restrict, by way of pre-approvals and treatment reviews, than many medical conditions, whose symptoms can be documented with blood tests or X-rays.”
- Do you think this is a fair statement? Why or why not?
- Discuss some of the responsibilities that managed care should have towards these individuals with mental health issues.
OPTIONAL READINGS:
Cancino, R. S., Jack, B. W., Jarvis, J., Cummings, A. K., Cooper, E., Cremieux, P. Y., & Burgess Jr, J. F. (2017). Health services utilization among fee-for-service Medicare and Medicaid patients under age 65 with behavioral health illness at an urban safety net hospital. Journal of Managed Care & Specialty Pharmacy, 23(7), 781-788.
Essock, S. M. (2016). What to do when the managed care firm says no. JAMA Psychiatry, 73(11), 1109-1110.
Guerrero, E. G., Garner, B. R., Cook, B., Kong, Y., Vega, W. A., & Gelberg, L. (2017). Identifying and reducing disparities in successful addiction treatment completion: Testing the role of Medicaid payment acceptance. Substance Abuse Treatment, Prevention and Policy, 12
Magaard, J. L., Seeralan, T., Schulz, H., & Brütt, A. L. (2017). Factors associated with help-seeking behaviour among individuals with major depression: A systematic review. PLoS One, 12(5) M. B., M.A. (2017). Mental health services in primary care. Contemporary Pediatrics, 34(3), 30-34.
Nierengarten, M. B. (2017). Mental health services in primary care. Contemporary Pediatrics, 34(3), 30-34.
Richard, D. (2017). What is next for behavioral health in managed care? North Carolina Medical Journal, 78(1), 30-32. doi:10.18043/ncm.78.1.30
Williams, M. O., Gilroy, J. R., Chang, T. Y., & Seymour, D. J. (2017). Challenges for insured patients in accessing behavioral health care. The Annals of Family Medicine, 15(4), 363-365.
Website
The Managed Care Information Center (2014). Retrieved from http://www.themcic.com/.
National Committee for Quality Assurance (2017). HEDIS and Quality Management. Retrieved from http://www.ncqa.org/tabid/59/Default.aspx
