Intensive case management for severely psychiatrically ill patients is a
relatively new phenomenon in the private sector. The authors describe a
comprehensive case management program designed at Blue Cross Blue Shield of
Massachusetts to meet the needs of the most severely ill psychiatric
patients in a private managed care environment. The case management program
emphasizes involvement of patients in creating comprehensive treatment
plans; development of a relationship between case managers, patients and
their families, and providers; and clinical coordination between the public
and private sectors to create individualized treatment plans. The program's
case managers are able to flex the benefit limitations of a managed care or
indemnity plan to integrate public and private services and can enlist
providers outside a managed care network. The paper describes service
utilization by the first 33 patients who participated in the program for
one year.
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