Introduction

Managed care refers to an organized system that focuses on care to ensure that it can balance cost, quality, and access in an effective manner. It can achieve this by cost-containment methods, provider selection, intensive care management, and utilization management. It is, however, unfortunate that providers in the public sector have antipathy concerning managed care. They usually seek to achieve the same ends through using the same means as those in the managed care organizations. Despite the existing attitudes, all the providers of behavioral health have to provide standard and quality care and treatment.

In the United States, it is quite hard to access the behavioral health services as compared to other health services. It is mostly because of factors such as coverage limits by private and public payers, and lack of enough qualified professionals in the field. Furthermore, managed care that is present in behavioral health services is increasing significantly. In the past, almost 80 percent of all individuals were either publicly or privately insured. They even received the behavioral health services from the managed care system. Later on, in the past decade, many of the state’s Medicaid programs are now providing the managed care. It is vital to know that the managed care plans in the mental health all have a unique feature that is quite different from the benefits that arise from general health care. This paper will provide a critical analysis of how managed care affects the manner, which behavioral health services are delivered. It will focus on both future and present trends, and issues that are involved in behavioral health services.

The Profession of Behavioral Health Services

In the modern health care scenario, the behavioral health services are now being viewed as being a profession. Most times, health care is often characterized by the mind and body dualism. It means that the physical and mental disorders are usually treated quite separately, but a lot of priorities is given to the physical health. Many resources are being used in the treatment of chronic and infectious diseases while few resources are used in addressing mental health issues. Even when it comes to training, the medical and mental health providers are treated differently. The prestigious and greater resources are allocated to the individuals that are undergoing the medical training (Unutzer & Schoenbaum & Druss & Katon, 2006). The result is that an imbalance exists when it comes to the number of people that are well-paid and well- trained in the mental health sector.

Fortunately, the behavioral health services are now viewed as a being a profession. They are often referred to as being mental health professionals since they seek to treat and improve the mental health of an individual. The issue first came about when there was a need to provide community personnel that provided community health services with a name. It means that the individuals have to receive some form of training so that they can provide the behavioral health services. Some of the professionals that provide these services include psychiatrists and psychologists, among others (Unutzer & Schoenbaum & Druss & Katon, 2006). It means that behavioral health services are now being recognized as being a mental health profession.

The behavioral health services are quite different from the other services that are in the health care industry. It does not receive the same amount of attention as the others, and the reason most people do not receive treatment. The field of mental health has some disparities with regards to the access and the availability of services. Furthermore, behavioral health services have not been fully integrated into the primary health care system. It is because it still focuses on a business model and traditional philosophy that is different from the dominant health care system. In fact, individuals that suffer from mental problems receive the treatment in different locations as compared to others that receive the mainstream treatment. However, if the behavioral health services are integrated into the mainstream health care, it will have some key similarities (Unutzer & Schoenbaum & Druss & Katon, 2006).

Behavioral Healthcare Reimbursement

For quite some time, the benefits associated with mental health insurance have been quite heavily managed and more restricted as compared to other forms of medical benefits. Many insurance plans cannot sufficiently cover the costs incurred by the provider such as essential services like care and screening management. In the past, Medicare, as well as other notable insurers, used to reimburse the providers of the mental health services. It took place at low rates than those of some somatic illnesses. In turn, this created an extremely overwhelming barrier for the individuals that were seeking the treatment needed for their mental health conditions (Covall, 2005).

Currently, the main financial barrier is that no parity exists when it comes to payment of the mental health benefits that are located under the Medicare. It is unfair since people that receive treatment for their physical health conditions are covered by up to 80 percent. On the contrary, the individuals that receive the mental health treatment only receive coverage of 50 percent. For example in the year 2002, according to the Medicare Payment Advisory Council, Congress had to make some key changes. Congress had to ensure that coinsurance of outpatient mental health was similar to that of the Medicare coinsurance, and especially for the outpatient services. It was established that because of the high coinsurance, an access and financial barrier for the needed care would come about. In addition, according to the Substance Abuse and Mental Health Services Administration, at least 14 percent of all the Medicare beneficiaries do not have the benefit to deductibles and coinsurance (Covall, 2005).

It is evident that reimbursement in behavioral health care is different from those of other known health care services, and it is based on the population that they serve. In behavioral health care coverage, reimbursement does not have parity provided by the Medicare as well as other private HMO insurers. Since the reimbursement rates are inequitable, it creates a barrier to individuals that want to obtain the behavioral health care. It also has an impact on the willingness and quality of service of the practitioners that want to enter into the field (Covall, 2005).

The behavioral health care tends to coordinate with a minimum of one player, and they are referred to as secondary payers. For example, Medicare covers many elderly individuals, but, unfortunately, it has gaps when it comes to the provision of services. When the elderly use the Medicare, they have to submit and work with the other insurers that include Medicaid to come up with supplemental plans. Furthermore, the problem that comes about is that the beneficiaries will have to be covered by commercial insurance, Medicare, and other insurers. The coordination of the benefits usually proves to be quite challenging. For example, the administrative work can be frustrating because of the multiple insurers that have to engage in billing. In turn, it takes a lot of time, and it is not possible to meet the deadlines, and thus no reimbursement. The factors that have to be addressed are vital since they affect the reimbursement mechanisms. They ensure the delivery of the behavioral health services and especially for the elderly is successful. The factors include the low provider reimbursement rates, the high cost of sharing and networks issues, and administrative burdens. Medicare has to ensure that it provides reimbursement and coverage, and this will improve the provision of the mental health services (Covall, 2005).

Challenges and Conflicts faced by Behavioral Health Providers

Behavioral health care providers that operate in the managed care environment experience some challenges, and they need to be known. First, they tend to have limited resources as not all of them can obtain the federal waivers, and especially the private ones. Secondly, it is usually quite hard to operate within the provided boundaries. It means that the behavioral health providers find it difficult when it comes to having the right attitude towards managed care. Thirdly, the providers of behavioral health services face the problem of the ever- increasing costs and the new laws that prevail (Oss, 2005). The result is that the mental health services become subjective as compared to the medical services.

Conflict exists in some particular areas between managed care and behavioral health care providers. The conflicts include differences in the personal status of individuals that handle the conflict and organizational power. Furthermore, it also includes the previous interactions that the managed care providers and behavioral health provides have had. In addition, the other conflicts are those related to legal and ethical issues as well as limited resources that prevail in the health care industry. Since the conflicts tend to affect the involved parties, it has lead to many problems that need to be solved. If the conflicts are not resolved, it can cause problems such as patients receiving sub-standard care. The mentioned conflicts have an impact on the two types of health care provision. However, the most crucial conflict is the sharing of limited resources, as this is known to cause problems in any organization even if it is not in the health care sector. When the limited resources have to be shared, it creates some form of tension in that the providers will not obtain all the resources that they need (Oss, 2005). In turn, the two providers will always be in conflict with each other, as they believe that they are better off than the other is.

Importance of Residential Treatment Facilities

Individuals with challenging behavioral health issues are often placed in the Residential Treatment Facilities. In turn, they benefit from the system of care approach, which facilitates the coordination between the community-based and residential providers, and thus encourages the people involved to become partners in the care. The managed care can then be successful when it comes to supporting services that are needed to provide the needed residential treatment. It means that by engaging in partnership, there will be mutual understanding and even the sharing of resources. All the concerned parties will ensure that they contribute towards their success. I also believe that some issues have to be considered to ensure that the Residential Treatment Facilities can always provide effective treatment. It should take place and ensure that they obtain reimbursement through the Medicare and Medicaid services. The issues include transitioning to the community-based services and ensuring the most appropriate placement, among others (Moniz & Gorin, 2006). The result will be that the providers of the insurance services will be more willing to provide reimbursement.

Conclusion

Based on the research that I have conducted, managed care plays quite a crucial role when it comes to issues concerning the behavioral health industry. Managed care ensures that available treatment programs are assessed. It assists in establishing how the services are delivered as well as identifying the elements that need to be preserved, and how they ought to be modified. They also play a role in coming up with a firm grasp on the various changes present in the state and federal reforms, which will affect their future and current funding mechanisms.

If I were a manager in a behavioral health care organization, I would make some changes that would bring about better business. In turn, it would assist in meeting the needs of consumers while also being able to receive reimbursement from the services the consumers are provided with. I would consider all the ethical and legal issues involved, and ensure that they are followed. Later on, I would ensure that both private payers and those covered by insurance can have access to the services provided. Lastly, I would inform all the employees as well as the individuals seeking mental health on how all reimbursement issues. Therefore, managed care plays an important role in behavioral health care.

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