TY - JOUR
T1 - A new approach to managed care
T2 - The provider-run organization
AU - Schwartz, Bruce J.
AU - Wetzler, Scott
PY - 1998
Y1 - 1998
N2 - Behavioral managed care has been dominated by for-profit carve-out managed care organizations who deliver mental health and substance abuse services by reducing services and fees to the detriment of patients and providers. We offer a new model of managed care based on a provider-run, hospital-based approach in which provider groups contract directly with HMOs and eliminate the managed care organization intermediaries. This approach allows providers to maintain or regain control of the delivery of behavioral health services. A model is presented of an academically based organization which has achieved utilization patterns compatible with the demands of payors. Innovations in service delivery, network management and fiscal issues are reviewed.
AB - Behavioral managed care has been dominated by for-profit carve-out managed care organizations who deliver mental health and substance abuse services by reducing services and fees to the detriment of patients and providers. We offer a new model of managed care based on a provider-run, hospital-based approach in which provider groups contract directly with HMOs and eliminate the managed care organization intermediaries. This approach allows providers to maintain or regain control of the delivery of behavioral health services. A model is presented of an academically based organization which has achieved utilization patterns compatible with the demands of payors. Innovations in service delivery, network management and fiscal issues are reviewed.
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U2 - 10.1023/A:1022186215834
DO - 10.1023/A:1022186215834
M3 - Review article
C2 - 9793111
AN - SCOPUS:0031689115
SN - 0033-2720
VL - 69
SP - 345
EP - 353
JO - Psychiatric Quarterly
JF - Psychiatric Quarterly
IS - 4
ER -