Overview

How can behavioral health clinicians provide managed care in an ethical, professionally satisfying way while also dealing with managed care organizations (MCOs)? This concise yet powerful volume will jump-start clinicians in their search for effective answers. Unlike other managed care guides, which tend to view the clinicianmanaged care relationship as inherently adversarial, this groundbreaking pocket guide (another in American Psychiatric Publishing's Concise Guides series) views resource management as a basic functionindeed, an allyof ethical clinical practice. True managed care both improves the quality of clinical care and protects community resources. It even stimulates patients to become more active managers of their own care. The author, speaking from extensive first-hand experience as both network provider and MCO administrator, asserts that clinicians must know how to manage care themselves to effectively persuade insurance companies to pay for treatment. Toward that end, the author details the practical tools clinicians need: basic principles and methods for making clinical decisions about behavioral health care when resources are limited, methods for communicating these decisions to patients and MCOs, and strategies for negotiating contracts. The author also focuses on four distinct clinical situations: providing nonacute, usually outpatient, services; providing acute crisis or inpatient services; seeking a network contract (negotiation strategies); and providing utilization management services. Invaluable to clinicians in everyday practice, this remarkable guide with its unique insights, collaborative approach, and case examples will also find a wide audience among clinical administrators in private and public MCOs who train network clinicians and utilization managers.

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9786611765118

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