Managed Care: It May Be an Opportunity

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It is well documented and clinically understood that the course of recovery from posttraumatic brain injury may extend over a long period of time. However, all too often a client's benefits are exhausted during the early phase of rehabilitation. As a consequence the client's emotional, psychosocial, vocational, and avocational rehabilitative needs are either addressed minimally or not at all. When these needs are not met it is not uncommon to find that clients regress from the level of independence they gained in the early phase of rehabilitation in which the majority ifnot all of their funds have been expended. To a considerable extent the lack of funds to finance the entire continuum of rehabilitation is related to reimbursement criteria established by the payors. These criteria focus primarily on frequency and intensity of rehabilitative intervention. Providers must demonstrate that a client requires intensive multidisciplinary intervention in order tojustif)' admission to and continued stay in an inpatient hospital or residential rehabilitation program. However, not all clients need the interventions of all disciplines nor do all clients benefit from the simultaneous intervention of all disciplines. The managed care approach holds the potential to allow providers the opportunity to more closely align their service delivery format with the prevailing needs of a client across the entire continuum of rehabilitation. Managed care will not base reimbursement on frequency and intensity of services provided by specified disciplines. Instead reimbursement will be based upon a predetermined and negotiated outcome, length