Monitoring Brain Injury Rehabilitation Services
This page, and the ones that follow it, contain much useful information that can help you to monitor rehabilitation services for brain injury.
INTRODUCTION
The first critical step toward achieving maximum recovery is careful selection of rehabilitation services which best meet the needs of the person with brain injury and their family. The second, and equally vital step in the rehabilitation process, is to participate actively in the decision-making about the monitoring of service delivery. Active and ongoing participation means you will be better prepared to make solid, informed decisions and to maximize available resources.
THE HEALTH CARE SYSTEM IN BRIEF
The 1980's brought radical changes to the health care industry in the United States. At the same time, the availability of specialized brain injury rehabilitation programs and services grew dramatically. Competition became a hallmark of the health care industry as first the federal government and then private insurance carriers began to rethink the way health care services were paid for. Reform of the nation's health care system began in earnest in 1993 when the federal government began to wrestle with ways to reduce the rapidly rising health care costs.
While National Health Care Reform, as a federally-led systems change was unsuccessful, it did spark a dramatic shift in the financing of health care services. The traditional fee-for-services model has given way to a wave of managed care models of funding and delivering health care services. Understanding the manner in which a particular managed care plan works and accessing medical and rehabilitation services has become increasingly challenging. Consumers must now make their way through "gatekeepers," accumulate referrals from a primary care physician to access specialized evaluation and treatment and appeal when requests for care are denied. The brain injury rehabilitation industry has changed in response to the growth of managed care, resulting in many mergers among provider organizations. Additional changes are expected as states recreate Medicaid programs into managed care models.
MODELS OF REHABILITATION
In the past, rehabilitation programs for people with brain injury were largely provided in a "medical model." While this model is still predominant, the trend is toward more community and home-based rehabilitation models. As the average length of stay in hospitals and rehabilitation facilities continues to fall, the importance of community services grows. Fortunately, providers of services are offering more community-based options. Negotiating with insurance companies, HMO's and other managed care entities to assure that a person with brain injury has access to the types, intensity and duration of services he/she needs is frequently necessary.
AN INFORMED CONSUMER MAKES THE BEST CUSTOMER
The purpose of this guide is to enable you to make well informed decisions about the services you or your family member receives. Through general guiding principles and specific questions, it provides a framework for the collection and evaluation of information regarding brain injury rehabilitation programs and services. Contact your Brain Injury Association state office or our national headquarters if you have questions or need additional assistance.