The vast majority of the criteria sets we reviewed, five of the seven, did not address coordination of mental health and physical health services (a worst practice). We believe this is a missed opportunity to improve the overall quality of the consumer's treatment plan and resulting health status. We offer the following statements as examples of best practices:

• "The patient's medical condition and the need for concurrent medical care must be addressed in the treatment planning process. With patient consent, regular communication and coordination of care with the patient's primary care physician is also considered an essential component of the treatment plan."

• "The treatment plan includes linkage and coordination with appropriate professional and community resources, especially when there are multiple service providers."

We also found many additional best practices in the internal staff training guidelines related to coordination with primary care, although these statements were not echoed in the corresponding criteria sets (a worst practice). Sample language is provided below:

• "Care managers are to consult with M.D.-level supervisors about concomitant physical conditions or medications which may impact the mental health/substance abuse treatment. Examples: diabetes, heart conditions, use of steroids."

• "Care managers are to consult with M.D.-level supervisors about coordination with Medical Insurance reviewers in such cases where the patient requires ongoing medical care, in addition to mental health/substance abuse treatment."

• "With the patient's consent, coordination of care with the patient's primary care physician is valuable for total health management."

• "In situations where there is more than one mental health/substance abuse provider, the Care Manager is to encourage regular communication and coordinated treatment planning and care."

Consultations

The panel was disappointed to discover that only one criteria set specifically addressed the need for consultations, particularly when the attending clinician does not have the necessary expertise. We offer the following statement from that document as a best practice in this area:

• "[Vendor] also requires that a provider has the appropriate training, qualifications, experience, and expertise to treat a particular case and reserves the right to request a consultation or second opinion on any case."

Key findings

"Report card" on information sharing

Methodology

Development process

Comprehensiveness

Corporate philosophy

Access issues

Compliance

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