Managed Mental Health Care: Myths and Realities in the 1990s

Dorwart, Robert A.

doi:10.1176/ps.41.10.1087

Cited by 55 publications

(28 citation statements)

References 7 publications

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“…In general, studies indicate that patients spend less time in treatment. Several investigators have reported that quality of care and treatment outcome do not necessarily have to decline, despite shorter treatment duration (Dorwart 1990;Patterson 1990;Coleman 1992). Whether or not this is being realized is not clear.…”

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confidence: 99%

Pediatric Psychopharmacology in a Capitated Managed Care System: How Do Patients Fare?

Bastiaens¹

1998

Journal of Child and Adolescent Psychopharmacology

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A retrospective chart review was designed to evaluate how pediatric and adolescent patients fare within a strictly managed, capitated outpatient psychiatric setting. The charts of 96 consecutively evaluated patients, treated by one psychiatrist, were reviewed. Standardized assessment tools were used to reach a DSM-IV diagnosis. The initial level of severity was defined by a Global Assessment of Functioning scale at the time of the evaluation, and improvement after pharmacologic treatment was measured by the Global Index of Improvement. Patients in this sample suffered from similar psychiatric disorders and similar levels of initial impairment when compared with those reported in other outpatient samples. Of the original 96 youths, nine patients were initially referred to their primary care physician for medication treatment, and 26 had been told that pharmacotherapy was not indicated. In the psychiatric clinic, psychopharmacotherapy was recommended for 61 of the 96 patients (64%), and 46 patients (48%) followed through with this plan. Of the 46 patients treated with medications, 72% improved within approximately 4 months of treatment, whereas 28% did not. Five of the 23 (22%) adolescent patients with major depression were hospitalized within 2 months of the initial evaluation. Most of these pediatric and adolescent psychiatric patients appeared to be treated satisfactorily, despite the strong limitations of a capitated outpatient service. However, significant limitations in time and resources necessitated a variety of clinical adaptations to maintain adequate delivery of mental health services.

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confidence: 99%

Pediatric Psychopharmacology in a Capitated Managed Care System: How Do Patients Fare?

Bastiaens¹

1998

Journal of Child and Adolescent Psychopharmacology

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“…By the mid-1970s, the federal government, insurers, and employers began to implement mechanisms to contain these costs.1113 Higher deductibles, the growth of health maintenance organizations, higher co-payments, and the exclusion of treatment for certain diagnostic conditions were among the mechanisms used. 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…”

Section: Literature Reviewmentioning

confidence: 99%

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

Keefe

Hall

1999

The Journal of Behavioral Health Services & Research

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This study investigates how social workers, psychologists, and psychiatrists document the treatment they provide clients to managed behavioral health care organizations. The rosters of the Register of Clinical Social Workers, the American Psychological Association, and the American Psychiatric Association yielded a sample of 168 private practicing social workers, 158 psychologists, and 258 psychiatrists from across the nation. Results indicated that practitioners differed based on age, amount of time spent in private practice, racial self-identification, percentage of time with clients diminished due to communicating with managed behavioral health care organizations, and documentation of clients' prognoses. Some practitioners believe it is necessary to report treatment needs in ways to assure certification rather than in ways that accurately depict clients' clinical profiles. The ramifications for clinicians' evaluation of their own practices, reimbursement for their services, and meeting clients' needs while working under managed behavioral health care guidelines are discussed.

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“…It is also about demonstrable outcomes. Dorwart (1990) argues that many employers would spend more money on employee coverage if they were assured the treatment was effective. Admittedly, utilization review programs have the implicit purpose of controlling &dquo;unnecessary&dquo; costs by scrutinizing the length, type of service, and the cost efficiency of the provider (Sharfstein, Dunn, & Kent, 1988).…”

Section: Utilization Management In Mental Healthmentioning

confidence: 99%

Practice Evaluation in the Context of Managed Care: Case-Recording Methods for Quality Assurance Reviews

Corcoran

Gingerich

1994

Research on Social Work Practice

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This article discusses the practice evaluation model in the context of quality assurance reviews in managed care. Managed care demands the three essential elements of practice evaluation; namely, specified client problems and treatment goals, suitable measurements, and analysis of change. The article delineates and demonstrates two case-recording procedures that facilitate quality assurance reviews of clinical social work practice.

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Managed Mental Health Care: Myths and Realities in the 1990s

Cited by 55 publications

References 7 publications

Pediatric Psychopharmacology in a Capitated Managed Care System: How Do Patients Fare?

Pediatric Psychopharmacology in a Capitated Managed Care System: How Do Patients Fare?

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

Practice Evaluation in the Context of Managed Care: Case-Recording Methods for Quality Assurance Reviews

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