Part of the concern is that New Directions will compare people with identical diagnosis but won’t bear in mind differences in the extent of their needs, Westerlund said.
Nov. Westerlund also raised privacy concerns about documentation that New Directions had told providers it will require. While another might need as much as a year to recover, one person with depression might feel better in four sessions, she said.
Blue Cross and Blue Shield of Kansas contracts with New Directions Behavioral Health to administer its mental health and substance abuse benefits, and New Directions will analyze practice patterns to determine how mental health providers generally treat a given diagnosis, Chambers said. Is an appropriate and applicablemodel for healthcare, deserves further discussion and review, whether a modus operandi that is necessary in wartime. They will ask for documentation to show the treatment was medically necessary, she said, Therefore in case they find outliers.
Chambers said insurers always was able to collect that information and aren’t seeking therapy notes.
Mary Beth Chambers, spokeswoman for Blue Cross and Blue Shield of Kansas, said the change brings the insurer’s mental health policies in line with its policies for other kinds of medical types care and with mental health parity laws. Presentation information in a mental health context could include whether a person was intoxicated, appeared to be tired or well rested, was crying or was calm, she said. Basically, eliminating prior authorization also will reduce paperwork for providers, she said.
In 1972, a billboard greeted travelers on I 70″ near MacVicarwith the words, Welcome to Topeka, Psychiatric Capitol of the World. Dr. Enthoven believed that identical systems analysis that applied to the battlefield of Vietnam, could also be applied to health care. TopekaState Hospital, The VA Hospital of Topeka, The Menninger Clinic, The YouthCenter of Topeka, Family Service and Guidance Center, the Shawnee County MentalHealth Center, and stuff A few years earlier in the course of the Vietnam War a Distinguished Professor of Economics at Stanford University, Alain Enthoven. You see, enthoven labeled this model managed competition which eventually morphed into the managed care of today. Assistant Secretary of Defense and hereupon Assistant Secretary of Defense for Systems Analysis. Thisreferenced Topeka’s Centers of Excellence for mental health treatment. In this command and control model a few experts at the top oversaw and directed the troops on the battlefield or the doctors and health care professionals in the consulting room or hospital. Dr.
Insurers have varying criteria to determine if a mental health service is necessary.
However, Blue Cross and Blue Shield of Kansas could recoup payments from providers if care was not determined to be medically necessary, she said. So emphasis might be on educating providers in the early stages, chambers said she wasn’t sure how much variation must be significant enough for a practice to be considered an outlier. More specific criteria are used to determine whether a patient should have sessions as infrequently as once per month or as often as multiple times per week. For the Blue Cross and Blue Shield affiliates, outpatient treatment is approved when the patient has a diagnosed mood or behavior disturbance that have enough chances to improve with treatment and demonstrates motivation for treatment.