Current mental health care environments: Why managed care is necessary.

Abstract

This book is a testament to the fact that managed care is beginning to affect the practice of professional psychologists, and more important, that this trend is likely to continue. To practice effectively within such an environment, psychologists need to understand the forces promoting the growth of managed care and the ways they stand to be affected by and potentially to benefit from this major shift in the way mental health and substance abuse treatment services will be delivered in the future (Bloom, 1990). Although professional psychologists have not been primarily responsible for creating the cost trends that have stimulated managed care in mental health, they, like all other professionals, will be affected. It will not suffice to proclaim professional innocence, although professional sophistication on the issues may have some positive effects.This chapter has four major purposes: (a) to review national trends in general health care costs and in health service delivery systems reacting to these cost trends; (b) to review comparable trends in mental health, drug, and alcohol treatment costs and service delivery systems that echo those in the general health system; (c) to make the case that managed care in the mental health industry arises as a marketplace response to concerns for service, cost, quality, and accessibility on the part of employers and insurers; and (d) to describe a general framework for understanding the structure of managed mental health care, while pointing to opportunities for psychologists who have cost-effective services to offer in a cost-and quality-competitive market. National Health Care CostsTrends in mental health can be viewed as a n echo of trends occurring in the broader field of general health. Of these, the rising costs of treatment, even after accounting for general inflation, have been the dominant concern among

Managed care is harmful to outpatient mental health services: A call for accountability.

“…Although in the 1980s mental health care costs covered by insurance were reported to be increasing at a rate greater than overall health care, the cause of this increase was generally attributed to increases in inpatient care (Ackley, 1993a; Broskowski, 1994; DeLeon & VandenBos, 1980; Frank, 1993; Lowman, 1991; Sharkey, 1994; Winegar & Bistline, 1994). From 1979 to 1988, private psychiatric hospital admissions increased 61%, from 319.9 per 100,000 to 515.6 per 100,000.…”

“…The managed care industry can be understood more easily when its diverse forms are grouped into generations. Although models with four or more generations of managed care have been described by others (Broskowski, 1993; VandenBos, Cummings, & DeLeon, 1992), a three-generation model is sufficient for analyzing the impact of the basic costs of managed care (I. J. Miller, 1994).…”

“…Because companies in this generation are not aggressive about reducing treatment, these are the type of companies that clinicians believe provide good managed care. Unfortunately, this type of managed care does not reduce expenditures adequately enough to be competitive in today's marketplace (Broskowski, 1993).…”

“…The following industry formula calculates the quantity of outpatient mental health services provided (Broskowski, 1993, 1994; Winegar & Bistline, 1994). 3 …”

Health reform and organized systems of care

“…Inpatient charges for adolescents grew by 65 percent between 1986 and 1988 (Frank, Salkever, and Sharfstein, 1991). Although care in less intensive settings is more broadly available, employers still spend an average of 70 percent of their mental health dollars on hospital-based services (Broskowski, 1990).…”