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Abstract
The micromanagement of the psychotherapy enterprise by private insurance interests has placed clinicians in new and unfamiliar roles in relation to their patients and to the professional marketplace. The value systems compatible with most managed care organizations are divergent from those held by an earlier generation of mental health professionals.
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Renz EA, Chung R, Fillman TO, Mee-Lee D, Sayama M. The effect of managed care on the treatment outcome of substance use disorders. Gen Hosp Psychiatry 1995; 17:287-92. [PMID: 7590192 DOI: 10.1016/0163-8343(95)00049-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study examined the effect of managed care and other reimbursement mechanisms on the outcome of substance abuse treatment at a single treatment facility. A retrospective review of 1594 patient records yielded treatment utilization, diagnostic, and demographic data. Recidivism rates for intensive managed care, traditional managed care, private pay, and state-funded groups of patients were compared. Results showed that, contrary to expectations, recidivism rates were not different for managed vs nonmanaged care patients. In addition, recidivist patients had significantly more ICD-9 diagnoses than nonrecidivist patients. A discussion of future research suggests that other outcome measures need to be examined in addition to recidivism rate, such as psychosocial functioning following treatment and indicator(s) of severity of illness, to better determine the effect of managed care and other reimbursement mechanisms on treatment outcome.
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Budman SH, Armstrong E. Brief therapy for managed mental health companies: becoming a learning organization. MANAGED CARE QUARTERLY 1995; 2:31-5. [PMID: 10133998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Nearly all of the services offered through managed behavioral health care companies are brief or time effective in nature. It is often the view of these companies that many of their providers have insufficient backgrounds in doing such treatment and have been trained in longer, less efficient modes of service delivery. Although this is often the case, what is frequently not recognized is that most managed behavioral health care companies themselves lack knowledge and clarity about such therapies. We address the critical need for behavioral health care companies to become learning organizations focused on research and development and internal as well as external training in time-efficient therapies. Such activities will allow for creativity and enhancement of the substance abuse and mental health care areas.
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Thompson JW, Belcher JR, DeForge BR, Myers CP, Henderson MJ. Trends in the inpatient care of persons with schizophrenia. Schizophr Bull 1995; 21:75-85. [PMID: 7770743 DOI: 10.1093/schbul/21.1.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This report analyzes nationally representative data to examine inpatient services provided to persons with schizophrenia. The data are for patients admitted to general hospitals, private psychiatric hospitals, and State and county mental hospitals between 1970 and 1986 (weighted n = 860,637). The proportion of admissions diagnosed as having schizophrenia decreased from 21 percent in 1970 to 16 percent in 1986; this proportion decreased in public general hospitals and increased in private general hospitals. The rate of admissions for schizophrenia decreased in public general hospitals and State and county mental hospitals and increased in private general hospitals. The overall admissions rate decreased for whites with schizophrenia and increased for African-Americans, owing entirely to increased admissions of African-American males. Private general hospitals and State and county mental hospitals relied less over time on private insurance; the use of Medicare increased in both public and private general hospitals; and Medicaid use increased in private general hospitals. Further research on services for this population is necessary as a baseline for health care reform.
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Finley JK. New Congressional approaches to health reform expected in 1995. BEHAVIORAL HEALTHCARE TOMORROW 1994; 3:76-7. [PMID: 10141043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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32
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Daniels AS. The role of capitation in quality behavioral healthcare systems of the future. BEHAVIORAL HEALTHCARE TOMORROW 1994; 3:80, 79. [PMID: 10143210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Capitation is more than just a challenge for the behavioral healthcare industry. It also presents an opportunity to develop comprehensive systems of care--driven by the appropriate use of technology and of quality methods--that will meet the needs of designated populations.
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Beck M, Rosenberg D, Miller S, Hager M. Managing the mind. NEWSWEEK 1994; 123:30, 32. [PMID: 10134528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Allen DW. Planning for the future of behavioral health services. HEALTH CARE STRATEGIC MANAGEMENT 1993; 11:16-9. [PMID: 10129055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Psychiatric and chemical dependency services are increasingly being delivered through managed care with greater emphasis on ambulatory and outpatient treatments. Inpatient facilities can preserve their involvement in behavioral health services by actively developing a managed care product line. This article describes the nature of change in behavioral services, what competitive behavioral health providers will look like in the future, and the actions hospital administrators should be taking now.
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Oss ME. Marketing guidelines for providers of mental health and chemical dependency services--responding to changes in the packaging and purchase of behavioral health benefits. Health Mark Q 1992; 10:129-36. [PMID: 10128818 DOI: 10.1300/j026v10n03_09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In summary, the mental health and chemical dependency market has changed to the point that providers and programs of any type can no longer survey financially without well-developed marketing strategies--including a conscious decision about target markets and niches within those markets. Behavioral health providers and programs need to thoroughly evaluate their internal resources, along with possible market niches, in order to develop these strategies.
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Kenkel PJ. Behavioral health managers take hold. MODERN HEALTHCARE 1992; 22:44. [PMID: 10122150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
With mental health and substance-abuse treatment costs averaging about 10% of a company's annual health bill, companies are looking for new ways to cap expenses. Some firms have decided to give specialists the job of managing the behavioral health portion of their medical benefits programs, according to a new survey of 350 companies by the Wyatt Co.
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Gelenberg AJ. If not now, when? J Clin Psychiatry 1992; 53:266. [PMID: 1500402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lutz S. In search of outcomes. MODERN HEALTHCARE 1992; 22:24-5, 28-9. [PMID: 10118665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Psychiatric hospitals, stung by reports of alleged abuses, are furiously trying to work their way out of an industry slump by embracing outcomes research. For them, such research may be a way to justify the value and effectiveness of their services with increasingly demanding payer groups. Although outcomes research is fairly common in medical/surgical hospitals, its existence is new to mental health.
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Parry G. Improving psychotherapy services: applications of research, audit and evaluation. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 1992; 31:3-19. [PMID: 1559116 DOI: 10.1111/j.2044-8260.1992.tb00964.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Psychotherapy services face increasing demand but are vulnerable to critical scrutiny by service purchasers seeking evidence of cost-effectiveness. Psychotherapy research, although it can benefit practitioners, cannot adequately address these concerns because of poor external validity and it is argued that complementary strategies are needed. A number of service-based evaluative methods are reviewed and the distinctions clarified between service evaluation, operational research, professional audit, service audit, quality assurance and total quality management. Maxwell's (1984) six category framework is used to examine a number of issues in psychotherapy services including the assessment process, treatment-of-choice decisions, predicting negative effects of treatment, dose-response in psychotherapy, brief interventions, therapist competence, clinical significance, cost effectiveness and measures of psychotherapy service inputs, process and outcomes. This review advocates reflective practice within a self-evaluating psychotherapy service and a systemic approach which can take account of the perspectives of patients, purchasers, service managers, referrers and practitioners.
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Smith JL. Trends in psychiatric outpatient services. HEALTH SYSTEMS REVIEW 1991; 24:28-30, 48. [PMID: 10111938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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White K, Shields J. Conversion of inpatient mental health benefits to outpatient benefits. HOSPITAL & COMMUNITY PSYCHIATRY 1991; 42:570-2. [PMID: 1907593 DOI: 10.1176/ps.42.6.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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42
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Dennison R. The impact of cost containment on psychiatric practice: implications and options. THE PSYCHIATRIC HOSPITAL 1991; 21:159-64. [PMID: 10115464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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43
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England MJ. Mental health care: buyers take the lead. BUSINESS AND HEALTH 1991; 9:58-9. [PMID: 10108960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Frank H. Partial hospitalization helps close insurance gap. CALIFORNIA HOSPITALS 1991; 5:17-8. [PMID: 10108937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Rodriguez AR. Directions in contracting for psychiatric services managed care firms. THE PSYCHIATRIC HOSPITAL 1990; 21:165-70. [PMID: 10115465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
An "irresistible force" has surely emerged in American healthcare; its name is Managed Care. It's a force embarked on an economic holy war, fired by the passions and anxieties of a competitive market economy that now seems uncommitted to spending more on health services. Its army is made up of an ununited confederation of utilization review organizations, health maintenance organizations (HMOs), preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and a number of other entities that have been enlisted to restrain++ the medical-industrial complex. In their march across America, they have frequently assailed the shibboleths and established structures of treatment systems, especially psychiatry and often fought with one another. While some are mercenary forces, others appear as peoples' armies, committed to preserving and strengthening the healthcare system they are transforming. As it encounters the inhabitants of this domain, Managed Care becomes both their master and their slave. As with any occupying force, it must win their hearts and minds over to the new way of doing things. The winning-over process is not going well now. Many patients and providers are angry at the inefficiencies, unproven effectiveness, administrative burdens, affronts to traditions, and threats to quality sometimes posed by Managed Care. This collective unrest has resulted in both a mounting resistance to the problems emanating from managed care changes in the healthcare system and a call to check its unrestrained incursions into professional practice through regulation. The growing tension between what seems an irresistible force and an immovable object can be viewed as part of the natural evolution of all change, particularly in a free market or in a society with requisite checks and balances.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cremerius J. [High frequency long-term analysis and psychoanalytic practice. Utopia and reality]. PSYCHE 1990; 44:1-29. [PMID: 2106151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
On the basis of the prognostic study of psychotherapeutic treatment in the Federal Republic and of the evaluation of more than 1000 applications for insurance benefits submitted in the years from 1973 to 1983, it is suggested that high-frequency long-term analysis is the exception rather than the rule and that it is carried on almost exclusively by a small group of "privileged" therapists. The author asks what this implies for the definition of psychoanalysis and for daily treatment practice. Are therapists being trained for a kind of treatment that they will rarely or never practice? The author urges resumption of the discussion of theory and technique of psychoanalysis in which these questions will be considered.
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Robinson ML. Psych: PPS may be out, but the pressure is on. HOSPITALS 1989; 63:28, 30. [PMID: 2722160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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50
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Abstract
Managed mental health care, which encompasses a wide variety of approaches, is a response to precipitous increases in health care expenditures, particularly as they relate to mental health care. The shift from what seemed certain to become a national health insurance program only 15 years ago to the profit-driven corporate health care industry of today is truly revolutionary. These profound changes are beginning to have a major impact on the independent practices of psychologists. In this article, psychologist practitioners are exhorted to recognize this new development in the marketplace. Data are cited that show the rapid shift from free choice care to various forms of managed care, and practitioners are urged to participate in shaping the changes that are now in process in order to develop a humane and effective system of mental health care.
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