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Part of Appendix C of TAP 16: Purchasing Managed Care Services for Alcohol and Other Drug Treatment: Essential Issues and Policy Issues

Overview of Checklist Contents

The checklist has 12 sections and a scoring summary. The scoring summary appears on page 55, at the end of the checklist. Also included is a list of answers to questions commonly asked by treatment providers who attend workshops on preparing for managed care.

The SERVICE COMPREHENSIVENESS section asks questions about the number and types of services you deliver, or whether you can access other needed services through strong network relationships. Managed care organizations in general prefer to purchase from providers that offer a range of services. Services for adults and adolescents are scored separately.

The questions in the SERVICE CHARACTERISTICS section ask about how services are delivered and focus on many of the selection criteria used by managed care organizations.

QUALITY ASSURANCE AND UTILIZATION MANAGEMENT (QA/UM) are staff activities that promote effective clinical management and service delivery. A well-functioning QA/UM program will compare agency practices against your standards and the expectations of the MCOs with which you have contracts.

Many substance abuse treatment providers operate EMPLOYEE ASSISTANCE PROGRAMS for small businesses or have relationships with employer EAPs. This line of business is an excellent preparation for managed care participation, and this section assesses this experience.

Participation in managed care frequently identifies a need to update the organization's MANAGEMENT INFORMATION SYSTEM (MIS), because rapid access to accurate information is required in order to interact with the MCO's case management staff. As providers are more frequently paid on a fee-for-service, per case, or capitated basis, management will need comprehensive and timely information concerning the amounts and types of services delivered.

Managed care participation may require that clinical staff and supervisors change some of the ways they deliver services. The questions concerning STAFF AND STAFF TRAINING address the issue of flexibility.

The healthcare system has been creating new affiliations, networks, joint ventures, and other partnerships in order to offer more comprehensive services and build stronger alliances. It may be advantageous for substance abuse treatment providers to consider such arrangements, as posed by the questions that deal with ORGANIZATIONAL RELATIONSHIPS.

The organization's board of directors and top management are extremely important to successful participation in policy setting and implementation of a managed care system. New knowledge and rapid decisions may be required. The BOARD AND MANAGEMENT questions focus on this area.

MARKETING becomes more important during a period when the financing structures are changing. The questions about marketing pinpoint several key actions that can increase visibility, referrals, and revenue.

The final two sections, on FISCAL ANALYSIS and BUSINESS OFFICE FUNCTIONS, concern revenue, cost analysis, invoicing, and internal service audits. These skills are important to financial status, contracting, and implementation.

The checklist starts on the next page. It is a freestanding instrument.

Last Updated 11-7-02