Study calls for MCO safeguards
Better protection is needed to ensure that managed care plans deliver high-quality care to people with mental health and substance abuse problems, according to a recent Institute of Medicine report.
Each year, roughly 52 million people experience some kind of mental health or substance abuse problem. Current quality control measures include voluntary accreditation by independent agencies such as the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance.
But as insurance benefits shift more Americans into managed care currently about 60% of the U.S. population is enrolled government accreditation organizations and managed care plans must take steps to protect consumers and monitor their care, the Institute’s report cautions.
The report recommends the following:
• Managed care organizations should provide consumers with a clear description of plan benefits and create straightforward grievance procedures.
• Managed care organizations should take steps to maintain patient confidentiality and eliminate so-called gag orders or other limitations that may prevent a clinician from discussing treatment options or providing appropriate care.
• Accreditation organizations should focus on results of treatment, such as whether patients experience fewer symptoms or return to work or school rather than on the structure and process of care.
• The federal and state governments should encourage the development of "report cards" to help inform consumers and their families about the quality of specific plans.
• The federal government should monitor the effectiveness of quality assurance and accreditation and should promote improvements in the tools used to measure health care quality.
• Primary care physicians should be trained to better recognize patients with mental health and substance abuse problems and either treat them or refer them to specialists such as psychiatrists, psychologists, or social workers.
The report also recommends that purchasers of managed care especially behavioral health care involve consumers and their families in treatment decisions and in measuring patient satisfaction and treatment effectiveness.
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