Provider groups and institutions must be able to run the business of these large systems with attention to the bottom line and in compliance with accrediting organization requirements. Traditional "back office" functions include practice management, billing and collections, human resources, cost accounting and budgeting. Additionally, these new systems must have centralized scheduling and record-keeping to support case management, triage and treatment planning. Quality assurance and provider credentialing programs must be in place. Marketing and sales, contract negotiations and recruiting are necessary for organizational growth.Management Information Systems
When clinicians and systems take on responsibility for large numbers of patients, they must be able to process vast amount of information.
Data that must be routinely monitored include information on client demographics, client insurance, client treatment such as short-term and long-term goals, utilization of services, provider performance and cost and outcome.Financial Issues
Three of the most important financial issues organizations must confront are capitalization, capitation and cost accounting.
Capitalization. Organizations must select the source of their funds for start-up, ongoing operations and growth. Possible sources include the providers' own pockets, banks, hospital and health systems, physician management corporations and venture capital.
Capitation. In order to bid for contracts to provide care to populations, organizations must have adequate information about the past medical experience of their "covered lives" and be able to evaluate this data.
Cost accounting and budgeting. Provider organizations and institutions must be able to operate like any success business with costs (clinical salaries, corporate expenses and office expenses) kept within the limits of revenues.Insurance Coverage
Clinicians participating in the newer delivery systems incur legal liability far beyond the real practice risks of traditional mental health care. In fact, utilization review, case management, responsibility for other providers and corporate business decision-making are specifically excluded from malpractice coverage. Clinicians must understand the place for vicarious liability protection, errors and omissions coverage, and directors and officers policies.Marketing and Sales
Clinicians no longer receive patients from traditional referral sources. Instead, patients are now channeled through distribution arrangements that result from managed care contracting. This change forces clinicians, networks and delivery systems to rethink how they can maintain adequate patient volume.