In the recent past, the field of behavioral therapy has attracted much attention from researchers who seek to unravel its effectiveness in meeting the needs of the disadvantaged groups. Consequently, most hospitals today are offering behavioral care to persons suffering from mental disorders, chronic illnesses, and those struggling with drug and substance abuse (Kelly, 2012). In the past few decades, the cost of health has increased tremendously, prompting the US government to adopt measures to contain the overheads. However, the reduction of cost must not compromise the quality of the services offered in different hospitals across the country. The adoption o behavioral therapy is in line with the managed care, which stresses the need to offer quality services at a reduced cost. Initially, behavioral treatment was not popular among the healthcare providers. The available insurance plans did not fund such treatment activities. However, following the findings by several researchers that behavioral care results in a better patient outcome and/or reduces the cost of health, more insurance companies are embracing it.
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This research paper explores the topic of behavioral therapy with reference to its operation in the United States. The paper commences by examining the perception of the US people about the professionalism of the behavioral therapy field of medicine. Next, the paper explores the difference between behavioral care and the traditional care. The differences between the duo systems are used to explain the reasons why the Medicare and Medicaid may reimburse the two systems differently. Lastly, the paper explores the challenges that behavioral healthcare providers face in the context of managed care. Based on the challenges, the paper gives several recommendations to remedy the situation.
People’s Perception of Behavioral Health Services
In the recent past, the behavioral medical care has evolved as a preventative and curative strategy for most of the deadliest chronic illnesses. Behavioral care has been linked not only to better patient outcome but also to the reduced cost of health (Covall, 2005). Consequently, most hospitals are embracing behavioral treatments to improve the health of their patients. However, in most hospitals, doctors also assume the role of counseling when treating patients. Therefore, the Behavioral Health Services (BHS) is yet to be recognized as a profession on its own. However, following the emphasis placed on the effectiveness of the behavioral therapy in increasing patients’ outcomes, most medical institutions around the globe have embraced behavioral care courses in their respective institutions. In turn, this move has contributed to the recognition of the Behavioral Health Services as a profession on its own. Additionally, it has led to the emergence of professionals in the field who specialize in the administration of behavioral care in hospital settings.
BHS differs from other healthcare services in several aspects. One of the differences between the two revolves around the kind of treatment afforded to the patient. Under the traditional care, professional physicians treat patients using medicines (Kongstvedt, 2012). However, behavioral care targets changing patients’ behavior to improve their health. Consequently, no medicinal treatment is availed to the patients. In most cases, behavioral therapy is administered orally. It is meant to avert the negative behaviors exhibited by a patient. The other difference between the two types of care is that traditional care provides short-term solutions to a sickness while behavioral care seeks to achieve long-term health. By altering the behavior of a person, the behavioral care promotes self-care, which is crucial to the achievement of long-term health.
Reimbursement of Behavioral Healthcare Relative to other Services
One of the reasons why behavioral healthcare may be reimbursed differently is that the costs involved in this form of care cannot be directly quantified. The behavioral care does not involve medical treatment, a situation that complicates the process of quantifying the costs involved in the provision of the service (Velasco-Mondragon, Jimenez, Palladino-Davis, Davis, & Escamilla-Cejudo, 2016). In the traditional system of care, medicinal treatment is involved. Hence, all direct costs may be traced. This situation makes it possible to quantify the costs and/or present the exact figures to Medicare for reimbursement. The other possible reason for the difference in reimbursement for the duo systems is that behavioral care is a continuous process, as opposed to the traditional one-time administration of the relevant treatment. The continuous nature of the behavior therapies may necessitate partial reimbursements as opposed to one-time reimbursement.
One of the issues that need to be addressed to streamline the provision of behavioral care is the nature of patients. Patients who require behavioral interventions are those who struggle with drug addiction and mental disorders (James et al., 2015). Also in need of the behavioral therapies are the people suffering from chronic illnesses. The three groups of people require different types of therapies based on their special needs. For example, for the mentally challenged, the treatment should focus on eradicating the negative behaviors that they exhibit. On the contrary, patients suffering from chronic illnesses need therapies that promote self-care.
Behavioral Healthcare Providers in a Managed Care Environment
One of the challenges facing behavioral healthcare providers in a managed care environment is the lack of adequate financing by the available insurance companies. As opposed to the primary care, which is fully funded by the government, behavioral care is an emerging field in medicine that is yet to gain the attention of the government (Oss, 2005). Although the government is slowly recognizing this field of treatment, it is yet to fully finance it. As it currently stands, the behavioral therapy is integrated into the primary care, as opposed to establishing new facilities for behavioral treatments. The other challenge that the behavioral therapists face is the high number of patients who require behavioral therapies. The US population is aging at a fast rate, a situation that is increasing the number of people who are in need of the behavioral treatment to mitigate chronic illnesses. Drug addiction, which is also on the rise, adds to the number of patients who require behavioral therapy. Under a managed care environment, medical practitioners are required to provide quality services at a reduced cost. The high number of patients creates gaps in the provision of quality behavioral therapies.
In terms of the areas of conflict between behavioral healthcare providers and managed care, medical ethics requires a healthcare provider to retain data pertaining to the patients as confidential as possible. Additionally, the practitioner must involve the patient in major decision-making (Oss, 2005). Patients undergoing behavioral therapies are usually drug addicts and the mentally challenged. Such groups are not competent enough to make sound decisions. The physician must consult family members or close relatives. This move compromises the autonomy and confidentiality of the patient’s data. Additionally, such patients may not offer reliable information regarding their health. This situation may limit the ability of the therapists to intervene. Other than the ethical issues, mentally challenged people and drug addicts are reluctant to seek medical services due to stigmatization. Such dishonor limits the ability of the behavioral therapists to understand the clients’ problems. The situation may lead to the wrong diagnosis. Based on the conflicts analyzed above, the ethical conflicts may be said to be the most challenging and crucial. The view is informed by the fact that the requirement that therapists maintain patient autonomy compromises the role of providing quality services at a reduced cost. Quality cannot be achieved without the right information from the client.
Managed Care and Residential Behavioral Treatment
In the recent past, the government has realized the effectiveness of behavioral treatment in fighting the symptoms of drug abuse, mental disorders, and the reduction of the severity of chronic illnesses. Consequently, the government has enacted various legislations to increase the funding for both inpatient and outpatient behavioral therapies. Hence, managed care environment will stand a better chance to support the services that are needed to avail efficient residential treatment. For example, Medicaid is currently reimbursing all costs if they are incurred in one of the following areas (Kelly, 2012):
- Personal and group therapies with doctors or other authorized individuals
- Annual depression screening, provided it is done by an authorized healthcare professional, a primary care doctor’s office, or primary care clinic that can provide follow-up treatment and referrals
- Family psychoanalysis if the primary goal is to assist in patient treatment
- Regular tests to establish if a patient is getting the right treatment
- Psychiatric evaluation
- Medication management
- Diagnostic tests
- An annual wellness visit to a doctor
In my opinion, based on the analysis of the above reimbursement requirements, residential treatment centers need to adopt several measures to benefit from medical insurance funds. One of the measures is that the facilities need to register with the relevant government authorities to be recognized as licensed behavioral medical centers. The facilities must always hire qualified psychotherapists to qualify for reimbursement by Medicaid. Adherence to the highlighted measures will ensure that the facilities obtain the necessary finances from the available healthcare insurance plans.
One of the changes that managed care has brought in the contemporary healthcare system is the introduction of behavioral care. Behavioral care in the US involves providing behavioral therapy to drug addicts, the mentally challenged, and patients suffering from chronic illnesses. The integration of the behavioral therapy into the traditional healthcare system has caused a decrease in the healthcare expenditures. Such therapies reduce the symptoms of addiction and mental illnesses, not to mention that it improves self-care among patients suffering from chronic illnesses. This strategy reduces the number of emergency cases, hence lowering the overall cost of health. However, although behavioral care is at the heart of reducing the cost of health, practitioners face numerous hurdles that limit their primary objective of offering quality services at reduced costs. Such challenges include poor financing and ethical issues among others.
One of the changes that I would implement if I were a manager in a behavioral health organization is that I would initiate group therapies for different classes of patients. Group therapies are more effective relative to individual therapies since they bring together people in different recuperation levels. Each group member contributes to the welfare of others. The already healed persons have the ability to pass the coping skills to starters, hence making the therapy effective. As indicated previously in this paper, Medicaid reimburses costs incurred during the administration of individual and group therapies. Additionally, I would encourage annual assessment of depression and outpatient/inpatient behavioral care.
Covall, M. (2005). Medicare prospective payment comes to psychiatric hospitals. Behavioral Health Management, 25(1), 54-56.
James, S., Freeman, K., Mayo, D., Riggs, M., Morgan, J., Schaepper, M., & Montgomery, S. (2015). Does insurance matter? Implementing dialectical behavior therapy with two groups of youth engaged in deliberate self-harm. Administration and Policy in Mental Health and Mental Health Services Research, 42(4), 449-461.
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Kelly, A. (2012). The cost conundrum: Financing the business of health care insurance. Journal of Health Care Finance, 39(4), 15-27.
Kongstvedt, P. (2012). Essentials of managed health care. Burlington, MA: Jones & Bartlett Publishers.
Oss, M. (2005). What’s next for managed behavior health? Behavioral Health Management, 25(6), 11-14.
Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G., Davis, D., & Escamilla-Cejudo, J. (2016). Hispanic health in the USA: A scoping review of the literature. Public Health Reviews, 37(1), 31-32.