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 More observations, recommendations, and areas for further study
Develop a consumer/family version These managed care firms have designed level-of-care criteria for use by clinicians. NMHA recommends that information about authorization processes be provided to consumers and families in a reader-friendly format. Use of global assessment of functioning scores Three of the criteria sets we obtained utilized Global Assessment of Functioning (GAF) scores. The panel had conflicting reactions to this approach. While we are pleased to see attention to functioning issues, this scale is not evidence-based. Clearly this is an area that needs more attention from the entire mental health industry. Court-ordered treatment While we are aware that court-ordered treatment is frequently denied authorization, the panel was perplexed that very few criteria sets (only two) addressed this topic, and both did so in a very brief manner. While we did not identify any best practices in the criteria sets we reviewed, we encourage the managed mental healthcare industry to continue to push for progress in this area. Prevention and early intervention None of the documents provided significant text concerning prevention and early identification practices. Although we could not identify any best practices in this area, we recommend more attention to this area so that some models may evolve and be replicated. Alternative medicine One criteria set contained text concerning acupuncture and herbs, and the panel could not reach consensus about this language. On one hand, we commend the vendor for having an expanded list of options for consumers. However, we are concerned about the lack of evidence-based research supporting these treatment modalities. Prescribing practices There was considerable variance regarding prescribing practices, particularly in terms of how soon and how aggressively medication versus therapy should be provided, as well as what type of clinician should be responsible for which functions. However, our [multi-disciplinary] panel wrestled with these issues as well and could not reach consensus. We believe this is another area in the field that requires further dialogue, and we will cover pharmaceutical benefits management issues in greater detail in another report in this Best and Worst Practices series.		Introduction 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 Acknowledgments