Privacy Issues in Mental Health and Substance Abuse Treatment: Information Sharing Between Providers and Managed Care Organizations: Final Report. 4. Case Management and Care Coordination

01/17/2003

Case Management.  MCOs may also use personal health information for case management and care coordination purposes.  MCOs may assign case managers to patients who use a high volume of services, to help them coordinate care between providers and to help them access community services.  Case managers may also be “go-to” people that can be contacted in a crisis, or between visits to the therapist.  The use of personal health information for this purpose is far less controversial, especially among consumers.  Consumer advocates we spoke with generally support the use of patient information for case management and care coordination as long as the patient approves it.  One advocate stated that patients distinguish between the sharing of information within and outside the health care system and feel comfortable with information being shared with people such as case managers or clinicians when their roles are to facilitate or participate in treatment.

Care Coordination.  It is often beneficial to the patient for information to be shared by the mental health/substance abuse provider and the primary care provider, particularly information that could prevent drug interactions (Simmons 1997).  Plans we spoke with generally ask the patient to sign an authorization for treatment information to be shared with the primary care provider.  MCOs do not so much collect this information as facilitate communication between providers.  Such care coordination is especially common when the mental health/substance abuse provider and the primary care physician work in the same clinic in a staff-model HMO.  In some cases, the providers may be able to share records electronically, further streamlining the process.

One mental health care provider we spoke with works with an MCO that automatically shares treatment information with the patient’s primary care provider.  She feels this is unnecessary, as some of her patients may have no relationship with their primary care provider, so the information is being shared with a stranger.  She would rather that the decision to share information with a primary care physician be made on a case-by-case basis.  Most providers we spoke with, however, said that in their experience, patients do sign an authorization for this information to be shared.

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