Best and Worst Practices In Private Sector Managed Mental Healthcare

Best (& Worst) Practices In Private Sector
Managed Mental Healthcare

Part I: Level-Of-Care Criteria
May 1999

"Report card" on information sharing

It is important to note that NMHA specifically decided not to use vendors' names in conjunction with any of the findings of this report, especially with respect to worst practices. Our goal is simply to re-enforce positive practices and reduce negative practices, without any "finger pointing."

However, one unintended finding of this project was that there is tremendous variation in terms of how forthcoming vendors are with information. Responsiveness to our requests for basic operational policies for this project varied from comprehensive and immediate to completely unresponsive. This latter category includes both companies that did not respond to multiple requests, as well as those that directly refused to provide materials because they considered them "proprietary."

NMHA strongly believes that purchasers, clinicians, consumers and their families have the right to know how the mental health delivery systems that affect them operate. In fact, most managed care organizations report to purchasers and accreditation organizations that their level-of-care criteria is available to the public.

For these reasons, secrecy and lack of responsiveness to public request for this material raises significant concerns about the content of the policies that are not provided-as well as concerns about how user-friendly these vendors are in general to inquiries from their clients, providers and enrollees. To that end, we do make an exception and offer the following "report card" in this one substantive area:

Report Card on Responsiveness to Inquiry about Level-of-Care Criteria
Comprehensive Care Corp.	F
Fallon Healthcare*	F
First Mental Health	F
Harvard Pilgrim	A
Kaiser Permanente-Northern California	A
Magellan	A+
MCC	A+
Oxford Health Plan*	F
PacifiCare Behavioral Health	F
Sentara Mental Health Management	A
United Behavioral Health	A+
ValueOptions	A+

The use of an asterisk notes vendors that informed NMHA that their level-of-care criteria are proprietary. Other vendors that received a failing grade without an asterisk did not respond to multiple requests by phone, correspondence and fax (at least 5 attempts per company). Those who received an "A+" provided materials immediately and even shared drafts in development before releasing them to their own staff and network providers. Others who shared the information on a timely basis received an "A."

Introduction

Key findings

"Report card" on information sharing

Child and family issues

Substance abuse and co-occurring disorders

Cultural competence

Provider autonomy

Coordination/ consultation among providers

Denial notification and appeal processes

More observations, recommendations and areas for further study

Acknowledgments