Critical mandates: prevention and health promotion.
Health maintenance organizations are supposed to maintain health, not just contain the cost of treating illness. Prevention and health promotion are critical mandates for managed care organizations, including managed behavioral health plans. More often than not, however, health plans have neglected to include prevention and behavioral health promotion services within their spectrum of covered benefits. In this article, the authors explain why there is a growing trend toward including coverage for prevention and promotion services in managed behavioral health plans, including the financial advantages and cost-containment opportunities that result. The article also illustrates several simple and straightforward models for structuring prevention benefits, managing the utilization and quality of prevention services, and including community-based preventive services organizations in provider networks.
Stoil
M J
MJ
Conwal Inc., McLean, VA, USA.
Hill
G A
GA
D003284:Contract Services / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated; D019468:Disease Management; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration*; D019458:Insurance Coverage / Q000639:trends; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration*; D017146:Models, Organizational; D009937:Organizational Objectives; D011314:Preventive Health Services / Q000191:economics / Q000458:organization & administration*; D012017:Referral and Consultation; D014481:United States