Review Accreditation Commission (URAC) all play roles in accrediting managed care plans that cover mental health and substance abuse care. The American Managed Behavioral Healthcare Association, NCQA, the Substance Abuse and Mental Health Services Administration (SAMHSA), and a number of corporate buyers (e.g., Digital Equipment Corporation) have also developed performance rating systems.

• Accreditation organizations compete for accreditation business on the basis of their credibility with payers, providers, and consumers.

• Benefits consultants and other consultants are advising corporate purchasers and state agencies on procurement, contracting, and other aspects of accountability. This is a significant new industry.

• Data collection is an intricate part of the assessment of quality of care. Many of the data currently collected are internal, not validated by external sources, and may not be relevant to outcomes of care.

• Accreditation tends to focus on measures of the structure and process of care rather than on measures of clinical outcomes. However, examples of movement in the direction of outcome measurement can be found, such as consumer satisfaction surveys and measures of clinical appropriateness.

• Variability exists in utilization review (a formal assessment of the necessity for services and their appropriateness and efficiency), which can be done on a prospective (precertification), concurrent, or retrospective basis.

• In public systems of mental health and substance abuse care, uninsured and publicly insured individuals can often access a greater selection and intensity of benefits for behavioral health care than are available to individuals with private insurance.

• Federal and state government agencies sometimes require accreditation and specify which accreditation organization's standards will be accepted. This process is known as granting an accreditation organization “deemed status.” Thus, the organization is “deemed” to act in the public interest. Deeming is not done extensively in health care but is common in other sectors, such as in the construction industry.

• Quality improvement methods have great potential but are still in preliminary stages for mental health and substance abuse services. Existing behavioral health performance measurement systems have used different strategies in their development, with varying degrees of consumer involvement.

2.1 Public and private purchasers, consumers, providers, practitioners, behavioral health care plans, and accreditation organizations should continue to monitor and assess the quality of care in the following ways: