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 Development process
Most of the vendors in this study included some information about how their criteria sets were developed within the documents themselves. The panel selected research/evidence base, frequency of updates, and involvement of key stakeholders as the key considerations for assessing the quality of the development process. Any gaps in these subject areas were filled or supplemented by surveys conducted through telephone interviews with representatives from the respective managed care organizations being studied. Research/evidence base The panel noted that, in general, the criteria sets that incorporated research from the scientific community were more consistent with clinical consensus and accepted standards of practice. Two best practices we identified are as follows: Criteria contained more detailed bibliographies and literature reviews. Criteria relied more on the DSM-IV and practice guidelines developed by the American Psychiatric Association and American Academy of Child and Adolescent Psychiatry. Frequency of updates The panel noted that, in general, the criteria that were updated more frequently were of higher quality. The better practice on this continuum allows for updates due to improvements in medical practice, demonstrates a stronger partnership with the provider community, and is indicative of a philosophy based on continuous quality improvement. The following is an example of a best practice: "Our criteria set is updated annually--and more often if we receive good suggestions from our network providers." The following statement was selected by the panel as an example of a worst practice in this area: "This is our first update of the criteria set in more than three years." Involvement of key stakeholders The panelists noted that those vendors that had greater involvement of consumers, families, and advocacy organizations had more consumer- and family-friendly criteria. NMHA encourages expansion in these areas and welcomes requests from vendors who are seeking objective feedback. The following are three best practices the panel identified in terms of stakeholder involvement: All companies included moderate to extensive input from the clinical community. Two companies included enrollee feedback through their national advisory boards, which include consumers and family members. Two companies sought input from professional, consumer, family and advocacy organizations.		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