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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH
plan for such areas as member services and satisfaction, administrative services, organizational structure and philosophy, provider credentialing and performance monitoring, clinical services management, clinical delivery support systems, and confidentiality. Digital Equipment Corporation, for example, has specific requirements for the behavioral health services that it purchases:
alternative treatment settings,
quality management, and
prevention and early intervention.
Table 6.1 compares some of the more widely used behavioral health care standards.
Trends inQualityStandards in thePrivateSector
Because so many purchasers' efforts to become involved in prescribing methods and outcomes goals for quality accountability are in the early stages and because the state of population-based measurement systems is not refined, quality management in behavioral health and other clinical services is in the early stages but is evolving rapidly. As with most evolutions, an experimental phase precedes consensus about what constitutes the best approach.
In addition to the standards listed in Table 6.1, numerous employer coalitions, both local and national, are now embarked on efforts to establish performance requirements for managed care. Examples include the Managed Health Care Association, the Employer Consortium, the National HMO Purchasing Coalition, the Minnesota Buyers Healthcare Action Group, and the Pacific Business Group on Health. Many of these coalitions have significant participation by health services consumers and their representatives, such as unions, advocates, organizations, and insurance commission agencies.
The Foundation for Accountability (FACCT), representing a broad coalition of public and private purchasers and others, has begun to develop and test tools that will allow documentation of population-specific functioning, quality of life, satisfaction with services, and risk reduction for a number of medical conditions commonly seen in health plans, such as diabetes, asthma, breast cancer, coronary artery disease, and low back pain (FACCT, 1995). Mood and anxiety disorders represent other conditions whose prevalence and direct and indirect