Why Guidelines Matter

Our last survey of health plans found a marked increase in the reported required use of professional guidelines – 59% in this year's survey, compared with 41% in 2017 (see Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing and Delivery System). These guidelines include level-of-care and diagnostic criteria—tools to help clinical professionals make better-informed decisions with consumer care.

Health plans expect their contracted provider organizations to use their selected care standards. OPEN MINDS Senior Associate Deborah Adler explains:

These clinical guidelines are used during the utilization . . .