Understanding the intersection between quality improvement, managed behavioral health accreditation, and the private practitioner.
The many parties, which now possess a role in behavioral health care services, are each concerned about the quality of these services. The concept of accreditation of MBHOs differs little from the board certification and licensure mechanisms used to ensure a minimal standard of care among practitioners. In the same way that behavioral health patients use licensure to seek competent providers, payers use accreditation as a way to ensure that MBHOs, given the task of cost control, are also active in ensuring that cost containment does not translate into decreased quality of care. Accreditation has established standards that fundamentally require MBHOs to implement QI programs directed at assessing and implementing efforts to improve care on a systemic level. NCQA accreditation of MBHOs reflects an effort to both regulate a novel industry as well as establish standards that reflect an ideal of health care. Currently, relatively few MBHOs receive full accreditation. This suggests that NCQA maintains its ideals but also that many MBHOs do not have the quality improvement programs that adequately demonstrate an interest in assessing and improving upon continuity and population-based quality care. As a fledgling industry, MBHOs are subject to unique market demands and trial and error. These forces have alienated many practitioners who provide services to MBHO members; however, practitioners must be able to tease out those aspects of managed care that facilitate quality care for their patients. Fundamental to this is the need for practitioners to understand and contribute meaningfully to QI initiatives directed at meeting NCQA standards. Despite their impositions, the new demands they place on practitioners, and the conflicted relationship in which they take place, QI efforts reflect an effort on the part of accrediting organizations and MBHOs to define, through empirical assessment and improvement efforts, quality care at a systemic level. Such care directly relates to effective behavioral health care by ensuring that a population of members receives care over a continuum of time and setting. Accreditation standards ultimately translate into quality of care and service, which patients and practitioners as well as the other stakeholders in the health care marketplace, agree is important.