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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH Appendixes

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH This page in the original is blank.

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH A Committee Biographies JEROME H. GROSSMAN, MD,Chair (IOM), is the President and Chief Executive Officer of Health Quality LLC, a medical information management company in Boston, and a Scholar-in-Residence at the Institute of Medicine. He is the former Chairman and Chief Executive Officer of the New England Medical Center and Professor of Medicine at Tufts University, School of Medicine. Dr. Grossman has been active in the HMO movement, as an original staff member of Harvard Community Health Plan and a founder of the Tufts Associated Health Plan. Nationally Dr. Grossman has held several leadership positions in the Association of American Medical Colleges, the Council of Teaching Hospitals, the Academic Medical Center Consortium, and the Institute of Medicine. In 1988 he founded the Health Institute at New England Medical Center to pursue research and development of initiatives to improve the organization and financing of medical care to achieve better health outcomes. Dr. Grossman serves as Trustee/Director for several corporations and institutions, including Massachusetts Institute of Technology, Massachusetts Business Roundtable, and Arthur D. Little, Inc. In 1989, he chaired the IOM Committee on Utilization Management by Third Parties, and in 1990, he chaired the IOM Committee to Advise the Public Health Service on Clinical Practice Guidelines. ROBERT BOORSTIN has served as Senior Advisor to Secretary of State Warren Christopher since November 1995. From 1994 to 1995, Mr. Boorstin served as Senior Director for Speechwriting at the National Security Council, was responsible for writing and editing President Clinton's remarks on foreign policy, and accompanied the President on international trips. Prior to that position, he

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH served as Special Assistant to the President for Policy Coordination and helped develop communications strategy for the Clinton Administration 's health care reform efforts. As Deputy Communications Director for the Clinton/Gore campaign, Mr. Boorstin oversaw the policy and research staffs and the production of campaign documents, including the candidates ' agenda, Putting People First. Mr. Boorstin has worked with several national consumer groups and has been active in speaking about mental health consumer issues since 1987, when he was diagnosed with manic depressive illness. He received his undergraduate degree in history from Harvard and did graduate work at King's College, Cambridge. Subsequently, he worked as a journalist for The New York Times and contributed to Newsweek, The Washington Post, and WBGH public television. Mr. Boorstin also founded and directed a New York City branch of the National Manic Depressive Association, which counsels people with mental illness and their families. JOHN J. BURKE is Executive Vice President for Workplace Services at Value Behavioral Health, in Falls Church, Virginia. Mr. Burke is the former President of Burke-Taylor Associates, the largest EAP in the Southeast. He has experience in Employee Assistance Programs (EAP) delivery, management and credentialing and has served as National Chair of the Employee Assistance Certification Commission. Mr. Burke has been a member of several committees for the National Employee Assistance Professionals Association and was a Co-Chairman of the Mental Health and Substance Abuse Committee for the North Carolina Health Planning Commission. Mr. Burke is a Certified Employee Assistance Professional (CEAP). M. AUDREY BURNAM, PhD, is Senior Behavioral Scientist for the RAND Corporation in Santa Monica, California. She has been actively involved in mental health and substance abuse research for over 15 years, directing studies on the epidemiology of mental health and substance abuse problems, and on delivery of services for persons with these problems. She is a Co-Director of the Drug Policy Research Center at RAND, and a Visiting Researcher to the Department of Psychiatry at the University of Arkansas for Medical Sciences. Her doctoral degree is in social psychology, and she completed post-doctoral training in mental health epidemiology and evaluation methods. BARBARA CIMAGLIO is Director of the Illinois Department of Alcoholism and Substance Abuse, and a member of the Board of Directors for the National Association of State Alcohol and Drug Abuse Directors (NASADAD). Her expertise is in state administration of substance abuse services and community-based care. She is a former board member of the National Prevention Network and the Illinois Women's Substance Abuse Coalition and several other organizations. Ms. Cimaglio is a clinically certified substance abuse counselor.

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH MOLLY JOEL COYE, MD, MPH (IOM), is Executive Vice President for Strategic Development at Healthdesk Corporation in Berkeley, California. Previously, she was Senior Vice President of Clinical Operations for the Good Samaritan Health System, Health Dimensions Incorporated, in San Jose, California. From 1991-93, Dr. Coye was the Director of the California Department of Health Services, where she directed MediCal's transition to managed care. She also was the Commissioner of Health in New Jersey and has served on the Board of Directors of the Association of State and Territorial Health Officials (ASTHO). Currently, Dr. Coye is on the Board of Directors for UMQC, which certifies managed care providers. Her past academic appointments include professor on the clinical faculty in the Department of Community Health at the University of California at Davis, Head of the Division of Public Health at the Johns Hopkins University of School of Hygiene and Public Health, and visiting professor at the UCLA School of Public Health. Dr. Coye is a former Medical Investigative Officer (Commissioned Corps) for the National Institute for Occupational Safety and Health. LYNNE DeGRANDE, ACSW, CEAP, is Senior Consultant to the Salaried Employee Assistance Program at General Motors Corporation. She was involved in the development and implementation of General Motors' EAP, where she interacts with managed care firms providing services to GM enrollees. Ms. DeGrande has more than 20 years administrative and clinical experience developing and managing behavioral health programs in corporate, industrial and health care settings. She is a member of the Corporate Advisory Board for the Washington Business Group on Health and serves on the Bio-Ethics Committee of St. John's Hospital in Detroit. Ms. DeGrande is a member of the Academy of Certified Social Workers, a Certified Employee Assistance Professional, and a Substance Abuse Professional with the Employee Assistance Professional Association (EAPA). RICHARD FRANK, PhD, is Professor of Health Economics at the Department of Health Care Policy at Harvard Medical School, and a Research Associate with the National Bureau of Economic Research in Cambridge, Massachusetts. Dr. Frank is a former professor with the Department of Health Policy at the Johns Hopkins University School of Hygiene and Public Health. He has published extensively on cost-effectiveness and costs of mental health/substance abuse treatment, the design of mental health benefits plans, health care financing, and the organization and delivery of health services. Dr. Frank was a staff member of the President's Task Force on Health Care Reform and a Commissioner for the Maryland Health Services Cost Review Commission. JOHN E. FRANKLIN, MD, is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Northwestern University Medical School, and the Medical Director for the Consultation Liaison Service at Northwestern's Stone Institute of Psychiatry. He is a member of the Executive Committee and the Utili-

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH zation Review Committee of the Department of Psychiatry and has many teaching responsibilities for medical students and residents. Dr. Franklin received an award for teaching excellence in 1986-87 when he was on the faculty of the New Jersey Medical School. He has served as a consultant to the National Institute of Drug Abuse and currently is Principal Investigator for an grant on homelessness. Dr. Franklin is a member of the American Academy on Addiction Psychiatry. MICHAEL F. HOGAN, PhD, has been the Director of the Ohio Department of Mental Health since March of 1991. The Department operates 14 accredited hospitals, funds and monitors services through 53 local/county boards, and serves over 150,000 citizens annually. Previously, he was the Commissioner of the Connecticut Department of Mental Health, the Deputy Commissioner in the same Department, and also held a variety of positions with the Massachusetts Department of Mental Health. Dr. Hogan has published many articles and book chapters on mental health services and policy, and he is a frequent speaker in national conferences on managed behavioral health care. Dr. Hogan received his doctoral degree in administration of special education from Syracuse University. DENNIS McCARTY, PhD, is a Research Professor at the Heller School at Brandeis University and director of the substance abuse group in the Institute for Health Policy. He is the Principal Investigator for Brandeis/Harvard Research Center on Managed Care and Drug Abuse Treatment, a health services research center funded by NIDA. The Center examines the effects of managed care on the organization and financing of services for the treatment of dependency on alcohol and other drugs. Previously, Dr. McCarty served as the director of the Massachusetts state authority for drug and alcohol abuse treatment and prevention services. He collaborated with Massachusetts Medicaid to facilitate the introduction of a managed care carve-out for mental health and substance abuse services. Dr. McCarty designed and implemented the current Massachusetts substance abuse management information system and also initiated a Quality Improvement Collaborative for substance abuse treatment programs throughout Massachusetts. J. MICHAEL McGINNIS, MD, MPP, is currently a Senior Policy Advisor and Team Leader for the World Health Organization's Health Reform and Reconstruction Programme in Bosnia, and a Scholar-in-Residence for the Commission on Behavioral and Social Sciences and Education at the National Academy of Sciences. As Deputy Assistant Secretary of Health from 1977-1995, Dr. McGinnis pioneered the development of public health objectives through directing the Healthy People 2000 initiative. Under his leadership, the year 2000 framework involved more than 10,000 individuals from national, state, and local public health agencies and organizations. Dr. McGinnis also directed the development of national guidelines for clinical preventive services, including screening and evaluation for substance abuse. He has published many articles on health policy,

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH health objectives, health economics, clinical preventive medicine, and other areas, and served as the editor of many reports for the U.S. Department of Health and Human Services. Dr. McGinnis is a fellow of the American College of Preventive Medicine and the American College of Epidemiology and has served on several boards and committees for the World Health Organization. Dr. McGinnis resigned from the committee in August 1996 because of his WHO commitments overseas. RHONDA ROBINSON-BEALE, MD, is the Senior Associate Medical Director for Behavioral Medicine at Health Alliance Plan/Henry Ford Health System. Dr. Robinson-Beale has been an administrative lead in the development of the behavioral medicine delivery system for HAP, a mixed model HMO, PPO, and POS. She has experience developing and implementing utilization and quality management activities within the HMO setting. As a provider, Dr. Robinson-Beale has managed a capitated behavioral medicine population which included private and public patients for ten years. Dr. Robinson-Beale has been one of the lead HMO representatives in Michigan during an initiative on the part of the State Department of Mental Health and Medical Services Administration to integrate the behavioral medicine care of Medicaid recipients between the HMOs and Community Mental Health. She has extensive experience in addiction medicine. She has worked in conjunction with the Detroit Department of Substance Abuse in the development of specialized addiction day treatment programs for pregnant addicts and their children and cocaine-addicted males. Dr. Robinson-Beale has served as a reviewer for the National Committee on Quality Assurance (NCQA), and has performed committee activities for NCQA. She has also served on the Committee on Standards for the American Society on Addiction Medicine and on the Quality Assurance Committee for the American Psychiatric Association. ALEX RODRIGUEZ, MD, is Vice President and Medical Director, National Account Consortium, Inc., a service company of Blue Cross/Blue Shield Plans that are committed to acquiring and retaining national accounts. For ten years, Dr. Rodriguez was the Chief Medical Officer of two national managed care companies, Preferred Health Care, Ltd. and subsequently Preferred Works/Value Health, Inc. Previously, Dr. Rodriguez was the National Medical Director and Director, Office of Quality Assurance of the Office of Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). He also served as Special Assistant to two Secretaries of the Department of Health and Human Services while he was a White House Fellow. Dr. Rodriguez is currently President-Elect of the American College of Medical Quality, and holds a faculty appointment at Yale University School of Medicine. He maintains an active medical practice in the Naval Reserve as a staff physician with primary care and psychiatric privileges

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH at the Naval Hospital, Groton, Connecticut, and at the National Naval Medical Center, Bethesda, Maryland. STEVEN S. SHARFSTEIN, MD, MPA, is currently President, Medical Director, and Chief Executive Officer at the Sheppard Pratt Health System and Clinical Professor of Psychiatry at the University of Maryland. A practicing clinician for over 20 years, he specializes in psychotherapy and psychopharmacology, especially for patients with long-term mental illness. He spent 13 years with the National Institute of Mental Health, where he was Director of Mental Health Service Programs and also held positions in consultation/liaison psychiatry and research in behavioral medicine on the campus of the National Institutes of Health. He has written on a wide variety of clinical and economic topics and has published more than 140 professional papers, 40 book chapters, and 10 books, including (as co-author) Madness and Government: Who Cares for the Mentally Ill?, a history of the federal community mental health centers program. A graduate of Dartmouth College and the Albert Einstein College of Medicine, he trained in psychiatry at the Massachusetts Mental Health Center in Boston from 1969 to 1972. Dr. Sharfstein also received a Master 's degree in Public Administration from the Kennedy School of Government in 1973 and a certificate from the Advanced Management Program at the Harvard Business School in 1991. He was Secretary of the American Psychiatric Association from 1991-95, and is a member of the Board on Neuroscience and Behavioral Health at the Institute of Medicine. DONALD L. SHUMWAY, MSS, is Co-director of Self-Determination for Persons with Developmental Disabilities, Institute on Disability at the University of New Hampshire. Mr. Shumway is the former Director of the Division of Mental Health for the New Hampshire Department of Health and Human Services, where he directed the development of New Hampshire's Medicaid 1115 Waiver for comprehensive health care reform. Mr. Shumway also was responsible for leading a legislatively mandated reengineering of the department and the reduction of the budget by $32,000,000. He restructured the state's mental health system and managed the first closing nationally, of all institutional services for persons with developmental disabilities. Mr. Shumway is a former member of the National Advisory Mental Health Council at the National Institute of Mental Health, and a former Board President of the National Association of State Mental Health Program Directors. CONSTANCE WEISNER, DrPH, MSW, is Senior Scientist for the Alcohol Research Group, a member of the faculty of the School of Public Health at the University of California at Berkeley, and an Adjunct Investigator for Kaiser Permanente Division of Research, Northern California Region. She directs the Community Epidemiology Laboratory, a large study of the epidemiology of alco-

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH hol and drug problems across populations of health and human services agencies and the general population. Dr. Weisner is Principal Investigator of NIAAA and NIDA research grants that study the cost and effectiveness of alcohol and drug treatment interventions in Kaiser. Other current studies examine access, utilization, and outcome across public and private sector programs. Dr. Weisner has been an advisor to the World Health Organization, the Robert Wood Johnson Foundation, the John D. and Catherine T. MacArthur Foundation, and state governments. She is a member of the World Health Organization Expert Advisory Panel on Drug Dependence and Alcohol Problems and was a member of the IOM committee that produced the report Broadening the Base of Treatment for Alcohol Problems. Committee Staff MARGARET EDMUNDS, PhD, joined the IOM in October 1995 as Study Director for Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care. From 1992 to 1995, she was an Assistant Research Psychologist at the Institute for Health Policy Studies, University of California, San Francisco, and the project director for a multisite clinical evaluation conducted for the California Department of Health Services. In 1991-92, she was the project director for the Primary Care-Substance Abuse Linkage Initiative, a national initiative on health care reform sponsored by the Public Health Service. From 1986-92, Dr. Edmunds was with the Johns Hopkins Behavioral Medicine Clinic, where she was a member of the affiliate staff of the Johns Hopkins Hospital, a clinical and research fellow (1986-89), an Instructor of Medical Psychology at the Johns Hopkins School of Medicine (1989-92), and a frequent lecturer with the Preventive Medicine Residency Program. Dr. Edmunds is a member of the Board of Directors and a Fellow of the Society of Behavioral Medicine. She has published articles on integrated health care delivery systems; financing and payment reform for primary care and substance abuse; clinical practice guidelines; smoking cessation; multidisciplinary treatment of chronic pain; and policy research. CONSTANCE PECHURA, PhD, Director of the IOM Division of Neuroscience and Behavioral Health, has a B.S. degree in psychology and a Ph.D. in anatomy and neuroscience. Following a post-doctoral fellowship at the National Institute of Neurological Disorders and Stroke, she joined the Institute of Medicine staff in 1988. She has directed projects and edited reports on a variety of topics including chemical weapons exposures to World War II veterans, integrating computer technologies to map the human brain, scientific and ethical issues of fetal and embryo research, mental and addictive disorders in women, ethical and science policy issues related to cross-species organ transplantation, and health and human rights. Dr. Pechura is a recipient of a National Science Foundation Graduate Fellowship, Uniformed Services University of the Health Sciences Out-

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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH standing Teaching Award, and National Academy of Sciences/National Research Council Special Achievement Award. Dr. Pechura holds an adjunct faculty position at the George Washington University School of Medicine, teaches a health policy tutorial in the Stanford in Washington program, and chairs the Board of Directors of Student Pugwash USA. MOLLA S. DONALDSON, MS, is Senior Staff Officer at the Institute of Medicine and adjunct professor at the George Washington University School of Medicine and Health Sciences (GWU). Currently she is project director the IOM's National Roundtable on Health Care Quality and its associated Managed Care Panel. She has been at the Institute of Medicine (IOM) since 1988 when she joined the staff as an Associate Study Director to develop a strategy for quality assurance in the Medicare Program. Since then she has directed studies on conflict of interest in patients outcomes research teams (PORTs), on development of a model process for setting priorities for health technology assessment, on clinical uses of antiprogestins (including RU 486), and on a study of regional health data networks that examined public disclosure of health information and protections for privacy and confidentiality. She co-directed a recently published report, Primary Care: America's Health in a New Era. Before coming to the IOM, she was Associate Professor at GWU in its primary care department. She directed the HMO's quality assurance program and taught in various medical school, health administration, and public health programs on issues of quality assurance, survey research, health services research in ambulatory care, and bioethics. Ms. Donaldson received a Masters of Science degree from the University of Virginia. She currently holds a Pew Doctoral Fellowship in Health Policy at the University of Michigan. CARRIE INGALLS, MPH, is a Research Associate in the Institute of Medicine's Division of Neuroscience and Behavioral Health. Since 1993, Ms. Ingalls has worked on several projects at the Institute of Medicine focusing on behavioral health care, substance abuse, genetics, fetal alcohol syndrome, environmental and occupational health, toxicology and environmental health information resources, and risk communication. Ms. Ingalls received her M.P.H. from George Washington University in 1995 with a concentration in health policy and programs. Her interests and research activities include epidemiology, health policy, and environmental and behavioral health. THOMAS J. WETTERHAN, MA, is a Project/Research Assistant with the Institute of Medicine (IOM). He received his MA in European Studies in 1994 from George Washington University's Elliott School of International Affairs. Since joining the IOM in 1995, he has worked on projects on behavioral health care, raising the profile of substance abuse research, genetics, toxicology and environmental health information resources, and the health of military women for the Division of Neuroscience and Behavioral Health and the Food and Nutrition Board.