NAMI Gives Failing Grade to Public Sector Managed Care

Flunk!

That was the verdict of the National Alliance on Mental Illness on the performance of nine managed behavioral health care companies serving mentally ill patients in the public sector.

The NAMI report, "Stand and Deliver: Action Call to a Failing Industry," gave a failing grade in every one of nine "measures of success" used to grade the performance of these managed behavioral health care companies.

"You are taking a gamble with your health" if you are cared for by these companies, said NAMI Executive Director Laurie Flynn, at a press conference in Washington, D.C., last month, at which the report was released.

"In order to get quality care, you have to be assertive and knowledgeable [about health care] in ways that most Medicaid--eligible people with severe brain disorders are not," she said.

"Our report card clearly shows that cost cutting is being done at the expense of the sickest individuals who are most at risk for disaster," said Flynn. "Managed care in the public sector will have tragic results for people with severe mental illnesses if the industry continues along its current path."

The nine managed behavioral health care companies profiled in the NAMI report are CMG Health, Green Spring Health Services Inc., Human Affairs International, MCC Behavioral Care, Merit Behavioral Healthcare, OPTIONS Health Care Inc., PacifiCare Behavioral Health Inc., United Behavioral Health Care, and Value Behavioral Health.

The nine "measures of success" were as follows: Are guidelines for treatment scientifically up to date and comprehensive? Is adequate hospital care available to all patients who need it? Is the most effective alternative to hospital care for people with the most disabling mental illnesses available to all who need it? Do patients have ready access to the most effective medications? Are suicide attempts handled as medical emergencies? Are consumers and their family members effectively engaged in their care? Are patient outcomes measured and used to determine policy? Are consumers assured access to rehabilitation services? Are consumers assured a stable place to live?

On all of these measures, NAMI gave the companies an F grade.

The report stated these conclusions:

• The managed care companies’ treatment guidelines for schizophrenia are out of date. They often do not even mention the newest antipsychotic medications, for example, and do not address the full range of care needed by people with severe psychotic illness.



• Hospital care is strictly limited, sometimes to criteria as strict as those for involuntary commitment. Most managed care companies do not specify that a qualified physician is required to deny hospitalization. And many described policies in which hospital care is denied for patients who are noncompliant and disruptive - "common features of severe mental illnesses," the report notes.



• No company sufficiently addresses the need to provide Programs of Assertive Community Treatment (PACT) - what the report calls "the best documented form of intensive case management shown to reduce the need for hospital care and to improve patient functioning."



• Few companies unequivocally state support for the use of new antipsychotic medications as a first line of treatment. Barriers to access are apparent for most of the respondents.



• Few companies define a suicide attempt as a medical emergency and have policies that ensure immediate care in such cases.



• Despite considerable activity and rhetoric about involving consumers and their families in managed care, the industry overall has failed to engage completely patients and their families in their own treatment planning, in education about the illnesses, and in providing feedback and oversight to the managed care organization.



• All of the organizations profess to have outcomes measurement, most with documented methods of feeding that information back into their systems of care. None, however, is systematically examining key outcomes for people with serious brain disorders and their families. "And at the present time," the report states, "consumers, families, as well as purchasers would be unable to identify the company providing the best care to people with severe mental illnesses on the basis of their outcomes performance."



• Most of the companies refuse to "own up" to the responsibility of ensuring that people disabled by severe mental illnesses have an adequate and stable place to live and are receiving rehabilitative services that are necessary for employment.

The results of the report are based on analysis of written survey responses from the companies.