Behavioral Health Essay
Read the following articles from the EBSCO host database:
Covall, M. (2005, January). Medicare prospective payment comes to psychiatric hospitals. Behavioral Health Management, 25(1), 54–57.
Oss, M. E. (2005). What’s next for managed behavioral health. (Cover story). Behavioral Health Management, 25(6), 11-14
You should also search the Internet to further learn about additional factors that influence the business model of behavioral health.
Your paper introduction (one page) should include the following points:
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An overview of the research paper
The purpose or objective of the research paper
The body of the paper (four to six pages) should address each of the following topics using information learned in the course, in combination with outside references:
In today’s healthcare scenario, are behavioral health services viewed as a profession? How? Is behavioral health service different from the rest of the healthcare industry? If yes, how? If no, why?
Describe the main reasons why behavioral healthcare may be reimbursed differently than any other healthcare services, in general Behavioral Health Essay. What factors need to be addressed based on the population served? Utilize your course and text readings to support your answers.
What are some of the challenges faced by behavioral healthcare providers who operate in a managed care environment? What are some of the areas of conflict between behavioral healthcare providers and managed care? Which amongst these conflict areas do you think is the most crucial, and requires immediate attention, and why?
Will the managed care environment be able to support the services required to provide effective residential treatment? In your opinion, what will a residential treatment facility need to continue providing effective treatment while still being able to get reimbursed, especially through Medicaid or Medicare services? (You can use the the CMS.gov Web site to get more information on these topics. Behavioral Health Essay)
Your conclusion (one page) should include the following points:
What conclusions can you draw from your research that would demonstrate the role played by managed care in the behavioral health industry?
If you were a manager of a behavioral healthcare organization, what changes would you bring to your ways of doing business to meet the consumers’ needs while still being able to be reimbursed for the services provided to the consumer?
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Behavioral Health Services
Introduction:
Behavioral Health refers to the general well-being of both the emotional and the mental status of an individual. In this manner, behavioral health ranges from individuals who struggle with disorders of substance or other addictive behaviors to those with mental illnesses such as personality disorders. For this reason, treatment is the only option for such individuals in regaining health status. To ensure that individuals seeking behavioral health services regain health status, they need not only to be supported but also to be empowered with efforts geared towards early screening with primary care doctors, early treatment and public health education Behavioral Health Essay.
The changes in behavioral healthcare service provision include but not limited to; better behavioral health benefits improved connections with social services, wider insurance coverage and efficient and integrated care among others. These changes are met with a variety of organizational arrangements which change the business setting of behavioral healthcare practices.
The purpose of this report is focused on the Business model of Behavioral Health in today’s healthcare setting and possible reasons which may contribute to different compensation methods in comparison with other healthcare services. In addition, a description of possible challenges likely to be experienced by healthcare providers who are operational in managed care environments will be provided. Also, this report will provide insight on the probability of managed care environment to support the provision of effective residential treatment to patients which enhances health outcomes Behavioral Health Essay. Lastly, possible recommendations will be provided regarding the best approaches to meeting clients’ needs and how to receive reimbursements from the same clients.
Behavioral Health Services in today’s Health Care Scenario
Behavioral health services range from the provision of mental health services to support and management of substance addictive disorders. Today’s Healthcare Scenario in behavioral health largely takes into consideration integrated care management approaches owing to the reforms in the setting where health care is organized, delivered and paid for (Oss, 2005). Besides, the acceptance and use of health information technology have also been an essential aspect in achieving behavioral health reform goals.
For this reason, Behavioral Health services are viewed as a profession since it consists of mental health experts who provide a variety of healthcare treatment approaches in depression, personality disorders, and substance-related addiction (Oss, 2005). These treatment approaches can also be provided by a behavioral health expert in assisting both nurses and doctors in patient management and related outcomes.
Behavioral health service tends to be different from the rest of the healthcare industry owing to its approach in ensuring patient outcomes. Behavioral health service methods largely consider a multidisciplinary approach in client management which caters for all the needs of a patient for effective outcomes (Moniz & Gorin, 2016). Essentially, other healthcare scenarios may only need the input of a single or two health experts in a specified healthcare filed or as a general practitioner to achieve timely and good patient healthcare outcomes. Behavioral healthcare ia extensive to the need of social services provision and exemplify the need for a multidisciplinary approach making it distinct in comparison to the rest of the healthcare industry Behavioral Health Essay.
Reasons behavioral healthcare may be reimbursed differently than any other healthcare services
Over the years when patients sought for behavioral healthcare services, in comparison to physical health care, the incidences of higher copayments as imposed by insurance were largely significant as it also affected service delivery. This disparity in funding between behavioral and physical health was evident and regarded by many healthcare providers and citizens as discriminatory and divisive (Covall, 2005). However, this discrimination was attributable to the insurance industry of the health sectors rather than societal or governmental actions. Even with the enactment of the Mental Health Parity and Addiction Equity Act of 2008, reimbursements in behavioral health still face a significant challenge Behavioral Health Essay.
The recent inequality that is likely to contribute to different reimbursement of behavioral healthcare is attributable to the increasing shortage of psychiatric hospital beds and closure of psychiatric hospital units. This is because, even with insurance coverage, it does not cater for the entire costs of patients on the mentioned units in comparison with the physical health care insurance which pays for up to 131% of costs (Rutigliano, 2010).
Owing to the underpayment pattern by clients who are not insured and public players with insurance overpayment to physical health, behavioral healthcare units continue to be underfunded with overpayments for costs of medical inpatient (Rutigliano, 2010). Behavioral Health Essay The trend of cost shifting has led to the closure of many behavioral health units. As a result, the burden of cost shifting is another reason that behavioral healthcare may be reimbursed differently than other healthcare services.
The major factors that ought to be addressed should ensure a reimbursement method that is not only reliable but also sustainable to meet the needs of both patients and behavioral health providers. In addition, the health policies of the insurance industry ought to be addressed to address the burden of cost shifting (Moniz & Gorin, 2016). Lastly, the market forces in the healthcare industry ought to be addressed to prevent most behavioral health providers from leaving the profession for higher sources of income Behavioral Health Essay.
The Challenges Faced By Behavioral Healthcare Providers Who Operate In A Managed Care Environment
Some of the challenges that faced the behavioral healthcare providers who provide behavioral health services within a managed care environment are the sweeping changes that have rocked the administration and reimbursements of their services. These challenges have led to a profound effect in the management of the health facilities and the general practice of the clinical social workers (Rutigliano, 2010). The role played by managed care companies in the delivery of behavioral healthcare service has also proven to be a major challenge to these entities. The rising costs of provisions of behavioral healthcare services that are associated with the rapid growth in the utilization of substance abuse and mental health services has also become a major challenge to these entities.
The areas of conflict between managed care providers and behavioral healthcare facilities are the delivery system that has reinforced mental health parity (Moniz & Gorin, 2016) Behavioral Health Essay. This reinforcement causes conflict when the behavioral health services are subjected to Medicare and Medicaid reimbursements, making it fall partly under the control of the managed care facilities.
Of all the conflicts between the two entities, the issue of reinforcing mental health parity is the most crucial. This is because it causes duplication of work, lack of clearly defines responsibilities and roles of the two entities and proper structures on how to manage the reimbursements form the financiers (Gregory, 2013). Thus, this is a conflict that may delay are hamper the effective delivery of residential treatments to the deserving customers. It is, therefore, a very crucial conflict that requires immediate attention to avert any possible adverse effect on the operations of the behavioral health service organization and the managed care organizations.
The Ability of the Managed Care Environment Be Able To Support the Services Required To Provide Effective Residential Treatment
The managed care environment has the potential to support the services deemed essential for the provision of effective residential treatment. Form a personal opinion, the residential treatment facility will need drugs, psychosocial support, family support, healthcare intervention measures, civic education, and counseling so as to be able to provide the behavioral health services (Gregory, 2013). Managed Care environments possess the ability to offer all the required healthcare service for an effective residential treatment that will use ambulatory and specialty facilities which are necessary for the continuous provision of effective treatment to the patient. This, however, will only be possible under the Medicaid or Medicare services arrangement. (CMS, 2017).
With these facilities, it is anticipated that the residential treatment facility will be in a position to continue providing effective treatment while at the same time be eligible for the Medicare and Medicaid reimbursement. The shift from single based behavioral healthcare treatment approaches to a group based behavioral healthcare practices in gradually happening in the society and thus is inevitable (Covall, 2005). A good example is the Affordable Care Act which is bringing changes that clients have been seeking for Decades. All these make the Managed Care environment be able to support the services required to provide effective residential treatment (CMS, 2017) Behavioral Health Essay.
Conclusion
From this research, it can be concluded that the role played by managed care in the behavioral health industry is to provide an environment that will support the provision of behavioral health services. The research also showed that the managed care environment has the potential to support the services deemed essential for the provision of effective residential treatment. Managed care poses the ability to offer all the required health care service for an effective residential treatment which is necessary for the continuous provision of effective treatment as the patient continue to get reimbursement. These, however, will only be possible under the Medicaid or Medicare services arrangements.
Suppose a manager of a behavioral healthcare organization wants to achieve the provision of an effective residential treatment service, then it would be important to improve the Managed Care environment to make it support all the health care service required. These changes will ensure that general practice of the clinical social workers. Meet the expectation of the clients Behavioral Health Essay. Thus meeting the needs and expectation of the consumers. Besides, these changes in the manner of doing business at the behavioral healthcare organization will help the manager achieve the objective of providing behavioral health services as a profession. Besides, it would be important to align all the behavioral health service provided to meet the reimbursements schedule of both Medicare and Medicaid. In addition, it would be important to address all the sticky issues arising from the diverse population that benefits from the provision of the behavioral health services.
Equally, the manager of the Behavioral Health Organization will be forced to address all the challenges facing the entity by having clearly defined roles and responsibilities. This will also include eliminating all the conflicts that arise between behavioral healthcare providers and managed care to ensure smooth operation. As a result, the behavioral health facility will continue to operate with reimbursement for the services provided to the consumer Behavioral Health Essay.
References
Covall, M. (2005, January). Medicare prospective payment comes to psychiatric hospitals.
Behavioral Health Management, 25(1), 54–57.
Oss, M. E. (2005). What’s next for managed behavioral health? (Cover story). Behavioral Health
Management, 25(6), 11-14
CMS (2017). CMS covers 100 million people. Available at
https://www.cms.gov/. Accessed on 29/10/2017
Rutigliano J (2010). Managed Care Trends And Mental Health Practice. Social Work
Today Vol. 10 No. 4 P. 8. July/August 2010 Issue.
Moniz, C., & Gorin, S. (2016). Health and Mental Health Care Policy: A Biopsychosocial
Perspective. 2nd ed. New York: Pearson Education, Inc.
Gregory Erickson (2013). Managed Care and the Mental Health Professions:
History and Effects on Outpatient Care. Student Journal of Psychology Copyright 2010 by the Department of Counseling & Clinical Psychology.2010, Vol. 12 Behavioral Health Essay