A New Approach to Managed Care: The Provider-Run Organization

A New Approach to Managed Care: The Provider-Run Organization Behavioral managed care has been dominated by for-profit carve-out managed care organizations who deliver mental health and substance abuse services by reducing services and fees to the detriment of patients and providers. We offer a new model of managed care based on a provider-run, hospital-based approach in which provider groups contract directly with HMOs and eliminate the managed care organization intermediaries. This approach allows providers to maintain or regain control of the delivery of behavioral health services. A model is presented of an academically based organization which has achieved utilization patterns compatible with the demands of payors. Innovations in service delivery, network management and fiscal issues are reviewed. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Psychiatric Quarterly Springer Journals

A New Approach to Managed Care: The Provider-Run Organization

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Publisher
Kluwer Academic Publishers-Plenum Publishers
Copyright
Copyright © 1998 by Human Sciences Press, Inc.
Subject
Medicine & Public Health; Psychiatry; Public Health; Sociology, general
ISSN
0033-2720
eISSN
1573-6709
D.O.I.
10.1023/A:1022186215834
Publisher site
See Article on Publisher Site

Abstract

Behavioral managed care has been dominated by for-profit carve-out managed care organizations who deliver mental health and substance abuse services by reducing services and fees to the detriment of patients and providers. We offer a new model of managed care based on a provider-run, hospital-based approach in which provider groups contract directly with HMOs and eliminate the managed care organization intermediaries. This approach allows providers to maintain or regain control of the delivery of behavioral health services. A model is presented of an academically based organization which has achieved utilization patterns compatible with the demands of payors. Innovations in service delivery, network management and fiscal issues are reviewed.

Journal

Psychiatric QuarterlySpringer Journals

Published: Oct 6, 2004

References

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