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General Medical Health Plan Integration
MH/SUD benefits are a part of physical health services paid from a single and unified budget. Independent purchaser and provider contracting for MH/SUD care ceases for all health plan business. Health plan divisions' work processes reflect one "health" product for all members, i.e. sales and marketing, customer service, health management, claims adjudication, actuarial projections, quality improvement, outcomes measurement and reporting, etc.
Why integrate physical health and MH/SUD? General Medical Health Plan Options There is a common misperception that MH/SUD diagnosis and treatment is so different from physical health that it needs to be handled separately. Advances in the past 20 years have demonstrated that most MH/SUDs can be as effectively identified and treated as most general medical illnesses (Kathol & Gatteau--Chapter 2). Importantly, the interaction between physical health and MH/SUD claims expenditures no longer make it economically reasonable to exclude MH/SUD services from the remainder of medical care. While treatment of MH/SUDs requires involvement by those with expertise in psychiatric illness, it can be effectively administered in the medical sector through the collaborative efforts of general medical and MH/SUD staff using the integrated workflow designs provided by Cartesian Solutions, Inc.™. While insourcing (carving-in) MH/SUD care is a necessary first step as a medical managed care organization moves toward more efficient, effective, and cost saving care for its members (see Table below), it creates lasting value only when MH/SUD benefits become a part of physical health benefits, i.e. management business practices are integrated. When this happens, duplicative physical health and MH/SUD work processes become obsolete. Support for MH/SUD assessment and treatment rolls into that for physical health at every level of the health plan. This can only be accomplished in discrete steps over several years. Cartesian Solutions, Inc.™ has defined these steps and can guide medical managed care companies through the transition process, avoiding costly errors, maximizing clinical and economic outcomes, and speeding the change process.
General Medical Health Plan Section
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What constitutes integrated physical health and MH/SUD care for a general
medical health plan?