Managed Care Services

In creating a managed care program, Duke Occupational Mental Health Programs (OMHP) collaborates with companies to develop enhanced services custom tailored to meet the organization's needs. Initially, we analyze the company's mental health claims experience to construct an appropriate, cost-effective system for managing mental health and substance abuse problems. Case management services include coordinating with the referral source to assure that the care rendered is appropriate, as well as no longer or more costly than that which is needed for the resolution or containment of the presenting complaints. Also included is aftercare and follow-up as needed to reduce the risk of relapse. Our case management services are integrated in such a manner that appropriate interfaces are maintained with the workplace (as needed and with releases) and with treatment resources. In addition, when the employee signs appropriate releases, we can consult with company supervisors on issues such as how to manage an employee receiving mental health or substance abuse treatment. We have developed considerable expertise in working with a broad range of vendors in ways which achieve positive results for our clients. At present we have systems in place which permit both verbal and written communication as needed. We believe that effective case management produces a positive treatment impact which in turn benefits the company by maximizing employee effectiveness and company productivity.

Duke OMHP utilizes several distinct case management models. Most commonly we have operated managed care services using an incentivized case management model. Using this plan we first seek to identify clinically appropriate and cost efficient options for the client, and then case manage the care. Duke can also function as a gatekeeper or alternatively, as a case manager of high risk mental health and chemical dependency cases. We believe that an EAP functions best as a gatekeeper when employees derive an additional benefit (typically in the form of lower co-payments) for utilizing the EAP. We also have experience working with organizations where we manage all mental health and substance abuse care and interface only with a third party administrator (TPA) or insurance carrier. With other organizations we manage all functions, including TPA activities. We also work with corporate clients for whom we coordinate with utilization review vendors and various managed mental health care systems.

Currently, Duke provides managed care (i.e., enhanced EAP) services for approximately 70% of its contracted companies. Our multi-disciplinary managed care team is comprised of a Certified Substance Abuse Counselor, Psychiatric Nurse, Social Worker, Psychologist, and Psychiatrist. We would be pleased to provide more details about the managed care (enhanced EAP) process and create a customized service to meet the needs of your organization. Please contact our office at 1-800-336-3853.