Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral health?federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers. Table of Contents FRONT MATTER SUMMARY INTRODUCTION TRENDS IN MANAGED CARE CHALLENGES IN DELIVERY OF BEHAVIORAL HEALTH CARE STRUCTURE ACCESS PROCESS OUTCOMES FINDINGS AND RECOMMENDATIONS GLOSSARY APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E APPENDIX F INDEX

Medicare, the world's single largest health insurance program, covers more than 47 million Americans. Although it is a national program, it adjusts payments to hospitals and health care practitioners according to the geographic location in which they provide service, acknowledging that the cost of doing business varies around the country. Under the adjustment systems, payments in high-cost areas are increased relative to the national average, and payments in low-cost areas are reduced. In July 2010, the Department of Health and Human Services, which oversees Medicare, commissioned the IOM to conduct a two-part study to recommend corrections of inaccuracies and inequities in geographic adjustments to Medicare payments. The first report examined the data sources and methods used to adjust payments, and recommended a number of changes. Geographic Adjustment in Medicare Payment - Phase II:Implications for Access, Quality, and Efficiency applies the first report's recommendations in order to determine their potential effect on Medicare payments to hospitals and clinical practitioners. This report also offers recommendations to improve access to efficient and appropriate levels of care. Geographic Adjustment in Medicare Payment - Phase II:Implications for Access, Quality, and Efficiency expresses the importance of ensuring the availability of a sufficient health care workforce to serve all beneficiaries, regardless of where they live. Table of Contents Front Matter Summary: Implications of Geographic Adjustment for Access, Quality, and Efficiency of Care 1 Introduction and Overview 2 Payment Simulations 3 Evidence of Geographic Variation in Access, Quality, and Workforce Distribution 4 Programs and Policies to Improve Access and Quality of Care for Beneficiaries 5 Observations on the Larger Policy Context 6 Recommendations Appendix A-1: Technical Approach to Payment Simulations: IOM Committee Recommendations for Hospital Wage Index and Physician Geographic Adjustment Factors Appendix A-2: Payment Simulations: Data Tables Appendix B: Methods for the Analysis of Associations of Quality Measures with Payments in Chapter 3 Appendix C: Quality Assurance for RTI Payment Simulations Appendix D: Public Session: Workforce, Access, and Innovation Policy Levers for Geographic Adjustment In Medicare Payment Appendix E: Exchange of Letters Between House of Representatives Quality Coalition and Committee Chair Frank Sloan Appendix F: Committee and Staff Biographies Index

Medicare is the largest health insurer in the United States, providing coverage for 39 million people aged 65 and older and 8 million people with disabilities, and reaching more than an estimated $500 billion in payments in 2010. Although Medicare is a national program, it adjusts fee-for-service payments according to the geographic location of a practice. While there is widespread agreement about the importance of providing accurate payments to providers, there is disagreement about how best to adjust payment based on geographic location. At the request of Congress and the Department of Health and Human Services (HHS), the Institute of Medicine (IOM) examined ways to improve the accuracy of data sources and methods used for making the geographic adjustments to payments. The IOM recommends an integrated approach that includes moving to a single source of wage and benefits data; changing to one set of payment areas; and expanding the range of occupations included in the index calculations. The first of two reports, Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, assesses existing practices in regards to accuracy, criteria consistency, evidence for adjustment, sound rationale, transparency, and separate policy adjustments to reform the current payment system. Adopting the recommendations outlined in this report will mean a change in the way that the indexes are calculated, and will require a combination of legislative, rule-making, and administrative actions, as well as a period of public comment. Geographic Adjustment in Medicare Payment will inform the work of government agencies such as HHS, the Centers for Medicare and Medicaid Services, congressional members and staff, the health care industry, national professional organizations and state medical and nursing societies, and Medicare advocacy groups. Table of Contents Front Matter Summary 1 Introduction and Overview 2 Labor Markets and Payment Areas 3 Hospital Wage Index 4 Smoothing the Borders of Labor Markets and Payment Areas 5 Geographic Practice Cost Indexes 6 Transitions Appendix A: Committee and Staff Biographies Appendix B: Public Committee Meeting Agendas Appendix C: List of Contributors and Participants Appendix D: Statistical Reliability of the Bureau of Labor Statistics (BLS) Wage Data Appendix E: Comparison of the Medicare Payment Advisory Commission (MedPAC) and Institute of Medicine (IOM) Proposals for Alternative Hospital Wage Indexes (HWIs) Appendix F: Description of Three Optional Sources for Facility Wage Index Data Appendix G: RTI Analysis Data Sources Appendix H: S-3 Worksheet Appendix I: Physician Work Adjustment Index