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

Abstract

This article reviews the forces leading to the current emphases on managed mental health systems. Rapidly escalating costs, especially for inpatient care, and associated concerns for quality and patient outcomes, have led third-party payers and employers to demand more eifective cost and quality controls. The article describes and illustrates methodologies for managing mental health costs, and reviews issues related to evaluating the impact of managed care on costs and quality of patient care. This special section 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 article 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.

The effect of technical support on clinician attitudes toward an outcome assessment instrument

“…2,3 As a result, various cost control strategies have been implemented by the purchasers of health care (such as businesses, governments, and insurance companies), including managed care strategies. [4][5][6] Managed care began in the 1980s with the implementation of diagnosis-related group (DRG) reimbursement practices by the federal government under the auspices of the Medicare program. 4 Additional managed care strategies have been implemented, such as documenting the medical necessity of care, fee schedule agreements (such as discounted fees and capitated plans), 5'7 the use of gatekeepers, 8 and utilization review.…”

“…[4][5][6] Managed care began in the 1980s with the implementation of diagnosis-related group (DRG) reimbursement practices by the federal government under the auspices of the Medicare program. 4 Additional managed care strategies have been implemented, such as documenting the medical necessity of care, fee schedule agreements (such as discounted fees and capitated plans), 5'7 the use of gatekeepers, 8 and utilization review. 9 An overriding theme of managed care has been paying only for services shown to be both medically necessary and effective.…”

Private practitioners' documentation of outpatient psychiatric treatment: Questioning managed care

“…12 Although these mechanisms were successful in reducing the use of health care services, they did nothing to curtail the use of mental health care services.14' 15 Geller reports that because the treatment for psychiatric care has historically been unregulated, there was little incentive for service recipients to modify their use of services.14 Broskowski cites the decreased stigma associated with mental illness, a willingness on the part of"baby boomers" to use their mental health care benefits, and more innovative approaches to treating mental health problems as additional reasons for the rise in mental health care service use. 11 Root notes that the inflation associated with mental health care treatment cost was due to the expansion of practitioner expertise, the lack of agreement on which treatment modalities are the most effective in treating specific mental disorders, and the etiology of mental illnesses and their effective treatment.~6…”

New Systems To Manage Mental Health Care

“…Application of the core managed care technology-utilization review and selective contracting-has led to drastic change in mental health practice. 3 Participants in the 1991 Utilization Management Survey conducted by the National Association of Private Psychiatric Hospitals (NAPPH) reported that most care is managed, with 78 percent of admissions requiring precertification and 74 percent undergoing concurrent review. 4 Approximately 28 percent of employers use special mental health provider networks, and approximately 22 percent of employee assistance programs (EAPs) are integrated with mental health benefits to facilitate early access and continuity of care.…”