Managing Values in Managed Behavioral Health Care

Abstract

Many mental health advocates harbor misgivings about publicly funded managed care for behavioral health services. As states and counties increasingly shift to managed care arrangements, these advocates view managed care cynically as just another attempt to justify budget cuts and reduce access to needed resources. As a consequence, they argue that the potential for great harm exists for behavioral health consumers in a managed care system, particularly for consumers with multiple, complex chronic needs.¹

Conversely, a growing minority of mental health advocates share a vision of a publicly funded managed behavioral health care system that succeeds where other public-sector systems have failed. These advocates see managed care as remedy for a dysfunctional public health system that lacks accountability, coordination among government agencies, and a continuum of care for behavioral health consumers. Their vision is premised on a commitment to certain basic, ethical values. “Values-based” publicly funded, managed behavioral health care systems emphasize the individual’s recovery while treating consumers as partners in their therapy and rehabilitation. These so-called values-based service plans are driven by consumers’ goals and build on consumers’ strengths while exercising responsible stewardship of scarce, public resources. In short, such plans strive to provide the right amount of care, at the right time, in the right setting, and for the right reasons.

According to these latter mental health advocates, their vision of public mental health will succeed where others have failed, in part because the delivery system integrates ethics into operations by utilizing a comprehensive corporate ethics program. Such programs have been in use in other industries since the late 1970s. Companies such as IBM, GE, Hewlett Packard, and Levi Straus, Inc. among many other Fortune 500 companies have instituted ethics programs as a means to strengthen their corporate cultures, increase productivity and boost long-term growth, as well as enhance their public image. It is not until quite recently that health service organizations have begun to reap the benefits of ethics programs.

A small but growing number of publicly funded, managed behavioral health care corporations have begun to make use of such programs. For example, Community Behavioral Health, Inc. (CBH), a Philadelphia-based public-sector managed behavioral health care corporation, utilized the services of the Center for Ethics in Health Care, in Atlanta, to implement a systemwide corporate ethics program. The program is largely an attempt to institutionalize the vision of Estelle Richmond, Health Commissioner, city of Philadelphia. This vision is of an integrated behavioral health system that supports a continuum of care. The commissioner’s vision includes (1) a commitment to a set of core ethical values, (2) an idea of the mission of public-sector managed care, and (3) a number of important, concrete goals for Community Behavioral Health, Inc. In this chapter, I provide an outline of this vision for public-sector managed behavioral health care. I consider this vision in light of the CBH Ethics Initiative. I discuss how the staff of the Center for Ethics in Health Care, Atlanta worked with management and staff at CBH to integrate ethics into the operations of CBH in an attempt to institutionalize Commissioner Richman’s vision.