Module 7 Flashcards
Schizophrenia, bipolar disorder, and major depressive order are this type of disorder. They profoundly disrupt a person’s feeling, thinking, mood, ability to relate, and capacity to cope with life’s demands.
Biological based disorder
This type of program separates mental health and chemical dependency services from a medical plan and provides them under a separate contract from a separate company known as a managed behavioral health care organization.
Behavioral health carve-out
This act extended mental health benefits coverage to include substance use disorder benefits. Financial requirements and treatment limitations for mental health/substance abuse can’t be more restrictive than for medical/surgical benefits.
Mental Health Parity and Addiction Equity Act of 2008
This type of program first focused on substance abuse problems and currently is used in a comprehensive approach to support members with a range of employee and family issues.
Employee Assistance Plan
A behavioral health facility designed to treat the most serious cases such as those who are unable to care for themselves and may have suicidal/homicidal tendencies
Acute inpatient facility
A cost containment practice that requires preauthorization to access treatment
Preauthorization for care access
A cost containment practice that analyzes claims data and identifies high-risk, potentially high-cost members and intervenes to avoid preventable treatment costs
Predictive modeling and risk assessment
A cost containment practice that collects data after the fact via provider assessment reports and claims data
Performance measurement
Cost containment that uses a manager to coordinate members’ care in collaboration with treating providers, facilities, community resources, + family members to ensure patients receive the right level of care
Case management
Cost containment that determines the medical necessity and appropriateness of treatment provided
Utilization review and management
Cost containment that uses developed tools to assess treatment effectiveness and quantify results
Outcomes management
Cost containment that considers medical and behavioral health care service results in conjunction with one another
Coordination of care
Cost containment that supports the clinicianpatient relationship and plan of care and emphasizes prevention of disease-related issues and complications using evidence-based guidelines and patient empowerment tools.
Depression disease management program
Cost containment that offers after-care programs to members who complete a course of chemical dependency treatment
Substance abuse relapse program
Drugs that affect psychic function, behavior, or experience that are part of the medical benefit and are generally administered by pharmacy benefit managers (PBMs).
Psychotropic medications
The majority of behavioral health benefits are purchased by large groups. Smaller groups are more likely to have behavioral benefits integrated into the general health plan, which may/may not have a specialty MBHO provide the behavioral benefit.
Market composition of behavioral health care benefits
This law plays an important part in protecting sensitive patient information gathered during behavioral treatment
Health Insurance Portability and Accountability Act
- Fully insured
- Shared risk
- Administrative services only (ASO)
MBHO funding arrangements
- Employee/employer awareness of the program’s services/value
- Appropriate use of benefits
- How well a vendor and its providers prevent/manage costly disorders
Requirements for an effective behavioral health care program
Granted by the National Committee for Quality Assurance
MBHO accreditation
Biological based disorder
Schizophrenia, bipolar disorder, and major depressive order are this type of disorder. They profoundly disrupt a person’s feeling, thinking, mood, ability to relate, and capacity to cope with life’s demands.
Behavioral health carve-out
This type of program separates mental health and chemical dependency services from a medical plan and provides them under a separate contract from a separate company known as a managed behavioral health care organization.
Mental Health Parity and Addiction Equity Act of 2008
This act extended mental health benefits coverage to include substance use disorder benefits. Financial requirements and treatment limitations for mental health/substance abuse can’t be more restrictive than for medical/surgical benefits.
Employee Assistance Plan
This type of program first focused on substance abuse problems and currently is used in a comprehensive approach to support members with a range of employee and family issues.
Acute inpatient facility
A behavioral health facility designed to treat the most serious cases such as those who are unable to care for themselves and may have suicidal/homicidal tendencies
Preauthorization for care access
A cost containment practice that requires preauthorization to access treatment
Predictive modeling and risk assessment
A cost containment practice that analyzes claims data and identifies high-risk, potentially high-cost members and intervenes to avoid preventable treatment costs
Performance measurement
A cost containment practice that collects data after the fact via provider assessment reports and claims data
Case management
Cost containment that uses a manager to coordinate members’ care in collaboration with treating providers, facilities, community resources, + family members to ensure patients receive the right level of care
Utilization review and management
Cost containment that determines the medical necessity and appropriateness of treatment provided
Outcomes management
Cost containment that uses developed tools to assess treatment effectiveness and quantify results
Coordination of care
Cost containment that considers medical and behavioral health care service results in conjunction with one another
Depression disease management program
Cost containment that supports the clinicianpatient relationship and plan of care and emphasizes prevention of disease-related issues and complications using evidence-based guidelines and patient empowerment tools.
Substance abuse relapse program
Cost containment that offers after-care programs to members who complete a course of chemical dependency treatment
Psychotropic medications
Drugs that affect psychic function, behavior, or experience that are part of the medical benefit and are generally administered by pharmacy benefit managers (PBMs).
Market composition of behavioral health care benefits
The majority of behavioral health benefits are purchased by large groups. Smaller groups are more likely to have behavioral benefits integrated into the general health plan, which may/may not have a specialty MBHO provide the behavioral benefit.
Health Insurance Portability and Accountability Act
This law plays an important part in protecting sensitive patient information gathered during behavioral treatment
MBHO funding arrangements
- Fully insured
- Shared risk
- Administrative services only (ASO)
Requirements for an effective behavioral health care program
- Employee/employer awareness of the program’s services/value
- Appropriate use of benefits
- How well a vendor and its providers prevent/manage costly disorders
MBHO accreditation
Granted by the National Committee for Quality Assurance
