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Author: American Psychiatric Association. Office of Economic Affairs and Practice Management Publisher: American Psychiatric Publishing ISBN: 9780890424537 Category : Capitation fees (Medical care). Languages : en Pages : 0
Book Description
In today's competitive economic environment, many psychiatrists are entering capitation agreements with managed care organizations. In exchange for a flat fee for each member of a benefit plan, the psychiatrist must provide all services needed by group members regardless of the amount of service required or its cost. The Psychiatrist's Guide to Capitation and Risk-Based Contracting provides the tools that will allow clinicians to navigate this complex process and develop a successful capitated program. It includes an overview of the primary financial, administrative, and clinical issues involved in such a contract. This guide contains helpful advice on how to calculate an equitable capitation rate, evaluate and negotiate a contract, minimize the financial risks involved, and resolve numerous other issues crucial to a successful capitation contract. An interactice mental health capitation demonstration disk especially designed and developed to educate psychiatrists about the interrelationships between mental health utilization, mental health service cost, and managed care capitation rates accompanies this book. By using this guide, clinicians will be able to manage this competitive environment in the best interests of their patients and their practice.
Author: American Psychiatric Association. Office of Economic Affairs and Practice Management Publisher: American Psychiatric Publishing ISBN: 9780890424537 Category : Capitation fees (Medical care). Languages : en Pages : 0
Book Description
In today's competitive economic environment, many psychiatrists are entering capitation agreements with managed care organizations. In exchange for a flat fee for each member of a benefit plan, the psychiatrist must provide all services needed by group members regardless of the amount of service required or its cost. The Psychiatrist's Guide to Capitation and Risk-Based Contracting provides the tools that will allow clinicians to navigate this complex process and develop a successful capitated program. It includes an overview of the primary financial, administrative, and clinical issues involved in such a contract. This guide contains helpful advice on how to calculate an equitable capitation rate, evaluate and negotiate a contract, minimize the financial risks involved, and resolve numerous other issues crucial to a successful capitation contract. An interactice mental health capitation demonstration disk especially designed and developed to educate psychiatrists about the interrelationships between mental health utilization, mental health service cost, and managed care capitation rates accompanies this book. By using this guide, clinicians will be able to manage this competitive environment in the best interests of their patients and their practice.
Author: Publisher: American Psychiatric Publishing ISBN: Category : Medical Languages : en Pages : 92
Book Description
Because of growing enrollment in managed care plans, psychiatrists are finding it necessary to sign contracts with managed mental health care programs in order to receive third-party payment. These contracts often lead to complications and form a key area of concern for clinicians. The Psychiatrist's Guide to Managed Care Contracting helps psychiatrists make sense of the legal issues arising from their managed care contracts. In a step-by-step manner, this useful guide develops the framework for the crucial decisions that must be made and highlights the strategies a psychiatric practice can employ to shape the contract in its favor. It reviews standard contract provisions and the issues involved so that potential problems can be identified early in the negotiating process. The Psychiatrist's Guide to Managed Care Contracting also details the essential groundwork and preparation that should be completed before a psychiatric practice enters negotiations, including practice assessment, financial planning, marketing, and the development of administrative support. Equipped with this knowledge and advice, psychiatrists can negotiate from a position of strength and develop a favorable contract that ensures the survival and prosperity of their practice.
Author: American Psychiatric Association. Office of Economic Affairs and Practice Management Publisher: American Psychiatric Pub ISBN: 9780890424506 Category : Medical Languages : en Pages : 112
Book Description
Because an increasing number of patients are covered through managed care plans, psychiatrists need to understand the managed care system in order to answer their patients' questions and ensure the continued prosperity of their practices. To assist clinicians in these challenging times, The Psychiatrist's Managed Care Primer arms psychiatrists with the information and tools they need to flourish within the managed care environment while simultaneously delivering quality patient care. This monograph provides an overview of the evolution of this industry; detailed explanations of current managed care models, operations, and anticipated trends; and practical advice on key problem areas. It focuses on the pressing issues of utilization management and capitation as well as important regulatory, ethical, and legal issues psychiatrists confront under this system. The potential impact that managed care systems have on their patient referrals, clinical decision-making autonomy, and income is also examined closely. Equipped with the sophisticated understanding of managed care supplied by this primer, psychiatrists can make the important decisions that will ensure the survival of their practice.
Author: Publisher: American Psychiatric Publishing ISBN: 9780890424513 Category : Psychiatry Languages : en Pages : 0
Book Description
As managed care companies gain increasing control over the mental health care market, many psychiatrists not under contract with a managed care plan have been excluded from significant numbers of potential patients. As a result, psychiatrists must pay more attention than ever before to practice management and other business-related issues. The Psychiatrist's Guide to Practice Management provides psychiatrists with important advice on how to make their practice capable of entering agreements with managed care organizations. This important guide identifies key areas (including financial, regulatory, promotional, administrative, and geographic issues) that must be considered in order to adapt the practice to make it more appealing to managed care companies. An additional chapter covers physician networks and alliances that compete directly against managed care organizations. It also provides crucial advice for psychiatrists who wish to develop a private practice based on traditional fee-for-service and private pay plans. By using this handy guide, psychiatrists can build a thriving practice inside or outside the managed mental health care system.
Author: Laurel J. Kiser Publisher: American Psychiatric Pub ISBN: 1585627984 Category : Medical Languages : en Pages : 335
Book Description
Until recently, behavioral health was defined within the strict dichotomy of inpatient and outpatient care -- a dichotomy that failed to mirror the range and complexity of human experience and clinical needs. Today's integrated system renders this dichotomy obsolete. Instead, service delivery integration processes offer an organized system of care rooted in a common vision and defined by processes intended to promote continuity and quality of care, coordination of efforts, efficiencies of operation, and seamless patient movement through an otherwise bewildering array of health care services. Unique in the literature, this volume brings together distinguished clinicians and policymakers who focus on the operational aspects of developing state-of-the-art integrated delivery systems. History and concept -- Why we need integrated health care delivery systems, including a model of service delivery integration that incorporates current barriers (e.g., ambiguous roles and responsibilities and lack of strategic alignment; how to design integrated delivery systems improving clinical outcomes, achieving fiscal and operating efficiencies, and aligning clinical and fiscal incentives) Structural foundations -- Access to the system of care for patients, payors, and employers; how to design level-of-care criteria; eight strategies that help clients move along the continuum; how to define level of care in today's managed care world; and the process of following therapeutic processes (i.e., philosophies, procedures, and practices used to create or support recovery and wellness) across the continuum Administrative and management processes -- How to reorient staff toward minimizing barriers and making the patient central to the system; documentation/information management and reimbursement (rates and rate structures, risk assumption); current research and its enormous potential to improve every aspect of care; quality assessments based on examining the driving forces behind the needs for monitoring and evaluating quality and outcomes; and the relation of behavioral health care systems, which seek to fully integrate clients and families into the fabric of their community and culture, to other systems A case vignette that highlights -- from the consumer's viewpoint -- the vital role of self-help during an episode of hospitalization and a discussion of future directions in integrated behavioral health care round out this remarkable volume. With its wealth of strategic and "nuts and bolts" information -- useful for alliances and single entities alike -- on how to harness operational forces in establishing an effective integrated behavioral health continuum, this volume will be welcomed by those who deliver direct services (psychiatric professionals) and those who administer and manage the integrated financing and delivery of quality care from public (U.S. government agencies) and private (managed care and insurance providers) sectors alike.
Author: Donald Harrison Caldwell Publisher: Jossey-Bass ISBN: Category : Medical Languages : en Pages : 634
Book Description
The second and thoroughly revised edition of the 1999 reference provides substantially expanded citations in vital areas such as institutional liability, genetics, managed care, integrated delivery systems, professional regulation, and antitrust law. This comprehensive reference work is unique in its scope, accuracy, timeliness, and viability. It is endorsed by the American Health Lawyers Association and the American Hospital Association.
Author: William Winston Publisher: Routledge ISBN: 1317786297 Category : Business & Economics Languages : en Pages : 347
Book Description
Managed care is a revolution impacting the practice of clinicians throughout America. The Clinician’s Guide to Managed Behavioral Care, called “a survival kit” and “must reading,” helps clinicians develop and market professional services attuned to the needs of managed care systems, manage the utilization process, and reshape an office practice or hospital-based program to become more “managed care friendly.” It is newly referenced and updated for clinicians to continue to advocate for their patients and clients.The Clinician’s Guide to Managed Behavioral Care addresses how clinicians can develop and market professional services attuned to the needs of managed care systems, how to best manage the utilization review process, how to re-shape an office practice or hospital-based program to become more “managed care friendly,” and how to best advocate for patients and clients. Readers will understand the history and evolution of attempts to manage mental health care costs and services as well as the emerging clinical, economic, and social trends that will continue to fuel changes in the mental health field in coming years. Importantly, this guide sensitizes readers to the perspectives about mental health care benefits and the treatment field held by the payor community--insurance carriers, HMO’s, and self-insured employers. It allows readers to consider a payor’s view of how professionals can play a crucial role in providing quality services while helping control spiraling mental health care costs--costs that have escalated much faster than other segments of health care.Who can benefit from this book? Practicing psychologists, social workers, psychiatrists, substance abuse counselors, marriage and family therapists, Employee Assistance Professionals, psychiatric nurses, professional counselors, program managers, hospital administrators, and health care marketing professionals will find The Clinician’s Guide to Managed Behavioral Care and invaluable resource.It is often said that in the future, all in the treatment community will be involved in “managing care” and that the most successful clinicians and practices will be those most adept at working with managed care systems on behalf of their patients and clients. This book helps you understand how!Important topics in The Clinician’s Guide to Managed Behavioral Care: the changing marketplace for mental health/substance abuse treatment services assessing market opportunities in light of managed care influences clinical service needs of managed care systems clinical innovations: examples, case studies, vignettes strategies for managing utilization review marketing strategies for office-based practitioners hospital-managed care partnerships contemporary office management strategies to control costs consumers and managed care directory of America’s HMOs directory of America’s Managed Mental Health Care Companies glossary of key terms
Author: American Psychiatric Association. Office of Economic Affairs and Practice Management
Author: American Psychiatric Association. Office of Economic Affairs and Practice Management
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Author: American Psychiatric Association. Office of Economic Affairs and Practice Management
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Author: Laurel J. Kiser
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Author: Donald Harrison Caldwell
Author: William Winston