In the United States, one out of four persons is likely to experience different forms of mental ailments and be suffering from comorbid physical fitness disorder. On a day-to-day basis, one of the patients may need behavioural health care assistance from a health facility. According to Oss (2005), managed health-care is considered a risk valuation and health care management clinically and money-wise. This is done to expedite pertinence and cost efficiency of health-care services within the restraints of whatever is reasonable.
This can be achieved by utilizing rule-based and medical management-based plans. In recent years, medical insurance providers such as Medicaid have continuously headed in the appropriate path on a successful model of behavioural health care services. The Psychiatric Prospective payment, initiated by the National Association of psychiatric systems, was developed to enhance behavioral health patients' overall experiences. The Psychiatric Prospective payment is mandatory for the health care facilities to enhance validity and reliability in guaranteeing that every patient is treated effectively. Considering managed care programs, both patients and management have an agreement to offer the programmes at an affordable rate. Managed care establishments may also generally assist in the management of utilization services offered.
Delegate your assignment to our experts and they will do the rest.
Managed care is often regarded as a health-care system and more of a routine and cost suppression technique. It also focuses on other components, such as the prevention and general quality of care service offered. For this research assignment, the focus will be on the behavioural health care services business model and the impacts of managed care on behavioural health industry. The principal objective of this research is to have an in-depth understanding of the several impacts on the delivery of behavioural health services.
Behavioural Health Services as a Profession
In recent years, a raging debate continues to ensue regarding whether behavioural services may be considered a career. Behavioural health services can be viewed as a profession. One of the aspects that make it a career is an emphasis on handling persons with psychological ailments. Nevertheless, it is comprehended by a range of other vocations. The careers are composed of; professional counselors, psychiatric nurses, psychoanalysts, sociologists, and social personnel. Each professional plays a critical role in administering behavioural health services. A majority of American citizens acquire psychological health care from specialized psychotherapists.
These counselors have attained high qualifications, such as having a masters degree and engaging families, persons, and groups. They lay emphasis on the treatment of mental, behavioural and emotional ailments and complications. General, they use mental and human advancements to deal with personal development, career progress, and wellness challenges. Experts in behavioural treatment, psychiatric health personnel, can nurse patients and offer modes of helping the patients and families handle the psychological ailments. Psychiatrists are qualified as physicians. They identify and also treat and assist in inhibiting patients with psychological fitness and emotive difficulties. Since they acquire training in mental health management, they comprehend the relations between medicinal and emotional disorders.
Reimbursement of Behavioural Health Services
While comparing the behavioural health services and other services in the industry; behavioural health services are varied. One aspect that differentiates the service from the elements is founded on the form of service offered. For instance, the health-care sector offers treatment to patients in health institutions, while behavioural health services can be delivered in a wholesome setting. Considering that several patients that pursue behavioural health services also agonize from prolonged ailments, it may be a daunting task for doctors to treat patients. This is as a result of the fact that most of the doctors have no expertise and preparation to handle both challenges. Another aspect is every service offered contains a customized code delivered by the Healthcare Common Procedure Coding System. The trials for the method of reimbursements under Medicare and Medicaid have remained a constant challenge.
Numerous elements decide how the process of reimbursement is conducted under Medicaid. This means that the patients and insurance providers are reimbursed reliant upon the case by case basis. This generally guarantees that there are no excess payments and also ensuring that every party is covered equally, in terms of finances. According to Zuvekas (2020) , nations can establish their own Medicaid insurance payment rates as per the federal requirements. Governments typically pay for provisions through programmes such as the fee-for-service or managed care provisions. Some of the factors that may be considered are founded on the rates for delivery of services and reviewing what commercial financiers pay in the private sector. Generally, the providers ought to have the readiness to consent to the reimbursement rates integrated under the Medicaid program. Consequently, a majority of the patients will retreat from the medical sector devoid of obtaining care for their health conditions.
Challenges Faced By Behavioural Healthcare Providers
While dispensing their duties, Behavioural Healthcare providers are known to experience a wide range of challenges. Foremost, health-care providers face the challenge of having to work devoid of any form of clinical security. It is demanding for health providers and practices when EHRs do not back discretion. Individuals suffering from mental ailments are faced with unique patient security challenges when acquiring health care. Regrettably, there is still a non-existence of cognizance regarding the unique concerns of health-care providers and patients. In addition, there is an absence of proof linked to these concerns. Patient discretion necessitates protection through the incorporation of clinical accounts and billing structures. On the other hand, the split-up of structures may make the organization of care more demanding.
Another challenge experienced by behavioural health-care providers in the absence of adequate evidence. As compared to the overall health-care, mental health has ailments that lack proof and procedures to specific prescriptions that are unconvincing. Another challenge involves a lack of integration. In many instances, a Psychiatry electronic health record policy doesn't assimilate appropriately with the health-care services. For EHR data-sharing to work faultlessly, it is essential for the health care system to connect efficiently, whenever required. Detached structures bring about tons of disseminated information and incoherent reports. This leads to difficulties in putting their EHR systems to optimum practice. Moreover, this also results in a consequential reduction in practicing efficiency, income, and patient treatment.
Areas of Conflict
There exist several regions of disputes between behavioural health and managed care. The areas include health care quality, ethical evaluation, and patient-doctor relations. Ethical analysis strain is a result of the frameworks in both managed care and behavioural management services, in which urgencies are viable. Amongst the challenges at hand, the quality of care is the utmost vital and requires instant consideration. This conflict is unavoidable and results in unfortunate or prejudiced services to patients. According to Reiter Dobmeyer and Hunter (2018) , if the emphasis is on the magnitude as compared to the quality, patients will not be guaranteed of quality health care. Quality ought to be always crucial as compared to the magnitude of the health care provided.
Managed care environment
Even though there is an upsurge in demand for behavioural health services, I am confident that managed care surroundings have the capability of supporting the services needed to offer efficient residential treatment. Residential treatment programmes are planned on offering an efficient mode of intensive therapy or assistance for persons experiencing severe mental ailment. Residential treatment programmes are favorable for persons with a particular ailment and are considered risky while dwelling in the community. This form of treatment is not accomplished in a patient’s place of residence, but they are accommodated in a facility. In this kind of facility, treatment is administered, overseen, and observed by specialized staff members.
From my point of view, a residential treatment amenity may require a residential treatment program to continue offering efficient treatment procedures. A residential treatment programme assists in the provision of discrete and group rehabilitation and offers encouragement and openings for family psychanalysis. This is achieved through on-site breaks, home pass, phone calls, and other forms of communication. Other means of a residential treatment process include continuous effectiveness. This is meant to embolden positive behaviors that may lead to a drop in a patient’s occurrences of hostility. Additionally, it may also be favorable to guarantee that the programme presented includes strategies adequate for enhancing safe behaviours. According to Oss (2005) in the case of patient victimization, it is vital to outlaw any kind of castigation or deeds of bullying. It is likewise extremely imperative to guarantee that the treatment offered is founded on evidence-based rehabilitation.
Incorporating Changes as a Manager
Based on the assignments research, managed care plays a critical role in the behavioural health industry. Regarding the behavioural health-care business model, there should be constant effort to guarantee the providers' quality services. This helps in terms of legal matters between patients and health providers. To guarantee that behavioural health-care providers are executing legitimate and reliable services, it is vital for these professionals to be experienced and well trained. In doing so, it promotes high-quality services and general upgrading of a person’s quality of life. Families that entrust the health-care specialists want to guarantee that loved ones receive equal and fair treatment.
Being a manager of a behavioural health-care facility, I may have to integrate various changes to enhance efficiency. Foremost, this would entail the formation of a strategy that stabilizes the financial independence of the organization. If a behavioural health organization fails to receive appropriate funding, it may lead to deterioration of services received by a patient. Funding plays a pivotal role in guaranteeing the type of services offered by professionals. The next adjustments may involve the integration of technology in the overall treatment procedures of patients experiencing mental ailments. Lack of sufficient gear or the essential resources may delay a person’s treatment procedure. Components such as electronic health accounts are incredibly significant concerning patient data and how it is circulated. Locating other choices for health-care analysis will also be one of the significant urgencies. Other changes that may be instigated include catering to the needs of the consumer.
The roles enacted by managed care mechanism in the behavioural health care sector seem to be an imbalance in the quality of care and services offered. Most of the challenges are attributed to a lack of funds and insufficient training of health-care providers, resulting in the ineffectiveness of managed care. Management of the costs is also a challenging aspect. Focusing on the cost and quality of the professionals and primary care may necessitate more states' involvement. This allows insurance providers such as Medicare and Medicaid to assist in financing and allowing patients to get access to services at affordable rates. Nevertheless, this does not enhance medical services but restricts the mental health services.
References
Oss, M. E. (2005). What's next for managed behavioral health. (Cover story). Behavioral Health Management, 25(6), 11-14
Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2018). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings , 25 (2), 109-126.
Zuvekas, S. H. (2020). Financing of Behavioral Health Services: Insurance, Managed Care, and Reimbursement. In Foundations of Behavioral Health (pp. 71-99). Springer, Cham.
