Comprehensive case management in the private sector for patients with severe mental illness.
Intensive case management for severely psychiatrically ill patients is a relatively new phenomenon in the private sector. The authors describe a comprehensive case management program designed at Blue Cross Blue Shield of Massachusetts to meet the needs of the most severely ill psychiatric patients in a private managed care environment. The case management program emphasizes involvement of patients in creating comprehensive treatment plans; development of a relationship between case managers, patients and their families, and providers; and clinical coordination between the public and private sectors to create individualized treatment plans. The program's case managers are able to flex the benefit limitations of a managed care or indemnity plan to integrate public and private services and can enlist providers outside a managed care network. The paper describes service utilization by the first 33 patients who participated in the program for one year.
Vallon
K R
KR
Massachusetts Department of Mental Health, Boston 021141, USA.
Foti
M E
ME
Langman-Dorwart
N
N
Gatti
E
E
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D054598:Blue Cross Blue Shield Insurance Plans / Q000458:organization & administration / Q000706:statistics & numerical data; D019090:Case Management / Q000458:organization & administration* / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D015276:Health Care Rationing; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008404:Massachusetts; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D017146:Models, Organizational; D010358:Patient Participation; D017149:Private Sector / Q000458:organization & administration*; D011369:Professional-Patient Relations