Q&A: Case management in behavioral health settings
Q: What silos do I need to be aware of as a case manager in a behavioral health clinic?
A: The healthcare community is subject to the forces of unintended consequences in that when the attempt is made to correct one problem, another one may be created as a result. We have seen this over the past 20 years with the move from managed care to care management. Each healthcare entity has “fixed” the piece they are responsible for correcting without the coordination of the whole patient picture. The case managers in each environment were subjected to working in the same silos of his or her employer.
The elephant in the room impeding integrated case management in a population health model is behavioral health. The compliance mandates around patients with psychiatric diagnoses is an example of the unintended consequences of healthcare laws implemented to protect the privacy of patients; however, the laws can seriously impede the case manager’s important care coordination work on behalf of the patients.
The health plans subcontract to behavioral health insurance carriers so that it is more difficult to track claims data for patients with medical and behavioral health diagnoses. It becomes a mindset for the behavioral health interdisciplinary team to treat the psychiatric condition and to transition care within the acute care setting and the behavioral health outpatient services, but the patient’s medical conditions may be largely ignored unless the facility or provider determines integrated case management is critical to the patient’s successful healthcare outcomes.
Conversely, the acute care hospital case manager is not inclined to recognize or know that the patient is under treatment for a psychiatric diagnosis and to coordinate behavioral healthcare for the patient prior to discharge from the hospital.
For more information, see Case Management Guide to Population Health. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.