An evolving continuous quality improvement role for managed care: a behavioral healthcare perspective

Managed care's initial continuous quality improvement impact may have been comparable to the sentinel, or Hawthorne, effect. Managed behavioral healthcare's CQI role can be compared with that of the clinical navigator. The clinical navigator attempts to develop a consensus with the patient on what is the clinical destination, and must choose a route to travel that is the best approach to reach the destination (i.e., a focused treatment plan). In addition, the clinical navigator tries to find the most efficient mode of travel--or, the least restrictive, least intrusive site of care from where the patient can receive treatment. Essential clinical tasks or expectations in the clinical assessment are also outlined, and the concept of knowledge coupling is introduced to accommodate the unique, individual issues of the patient. The emphasis of managed care today is shifting to further accentuate a CQI, outcomes-based approach.