Advocacy, Third-Party Payers, and Managed Care

Organizational change for mental health providers is becoming the rule rather than the exception as outside forces such as regulatory agencies and third-party payers exert increasing influence on the delivery of services. The pressure to adapt to shrinking budgets combined with demands for more effective services often puts many provider agencies on the defensive. In short, agencies must be able to demonstrate that they are, in fact, succeeding at cutting cost, increasing revenues, and improving effectiveness simultaneously. However, implementing organizational change is fraught with many challenges, not the least of which is the natural human resistance to change. This study provides a clear and simple process for identifying the most common reasons for the inevitable human resistance to change and suggests a strategy for overcoming that resistance to bring about successful organizational objectives.

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PSY15 STUDY OF FREQUENCY OF USE AND COSTS OF PATIENTS WITH CHRONIC PAIN AND NEUROPATHIC PAIN IN COLOMBIA FROM THIRD PARTY PAYERS PERSPECTIVE

Value in Health ◽

10.1016/s1098-3015(10)73017-5 ◽

2010 ◽

Vol 13 (3) ◽

pp. A207-A208 ◽

Cited By ~ 1

Author(s):

M Romero ◽

C Arango ◽

J Albanes

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Third Party ◽

Frequency Of Use ◽

Third Party Payers

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Managed Care Organizations' Assessment of Reimbursement for New Technology, Procedures, and Drugs

Archives of Pathology & Laboratory Medicine ◽

10.5858/1999-123-0677-mcoaor ◽

1999 ◽

Vol 123 (8) ◽

pp. 677-679

Author(s):

Harold Zarkowsky

Keyword(s):

Managed Care ◽

New Technology ◽

Third Party ◽

Medical Community ◽

Extensive Literature ◽

Behavioral Measures ◽

Randomized Controlled Studies ◽

Marginal Improvement ◽

Managed Care Organizations

Abstract Managed care organizations must establish formal processes for the evaluation of new technology, procedures, and drugs to enhance the quality of health care delivered and to support coverage and utilization decision making. Evidence-based research and the results of controlled clinical trials are the preferred sources of outcomes data to support the safety and effectiveness of the technology, procedure, or drug under review. In addition to extensive literature review, the opinion of experts in the field and acceptance by the medical community are considered. Assessments of new technology and drugs are available for purchase from several vendors, and managed care organizations can adopt or modify such evaluations to develop medical coverage policies. The research community can assist third-party payers by conducting studies on practices that might lead to substantial, rather than marginal, improvement in health, pay particular attention to study design when randomized controlled studies are not possible, and include functional and behavioral measures in analysis of outcomes.

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