Mental Health and Managed Care

Durham, Mary

doi:10.1146/annurev.publhealth.19.1.493

Cited by 7 publications

(2 citation statements)

References 41 publications

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“…In general, research on payment models has focused on specific segments of the health system, with findings that may not translate directly to the compensable rehabilitation sector, for example, outcomes in general medical practice [8][9][10] acute inpatient rehabilitation [11,12] and mental health services [13,14]. Very little of the published literature directly examines the impact of payment models on rehabilitation service delivery and work outcomes in workers' compensation systems.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape

Matthews¹,

Hanley²,

Lewis³

et al. 2014

Disability and Rehabilitation

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Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.

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Section: Introductionmentioning

confidence: 99%

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape

Matthews¹,

Hanley²,

Lewis³

et al. 2014

Disability and Rehabilitation

View full text Add to dashboard Cite

show abstract

“…Managed behavioral health care involvement is also spreading among psychologists and other mental health practitioners (Dickey, 1997; Domino, Salkever, Zarin, & Pincus, 1998; Durham, 1998; Phelps, Eisman, & Kohout, 1998). This trend, too, is not restricted to the private sector.…”

Section: Introductionmentioning

confidence: 99%

Provider profiling: What works for medicine works for mental health?

Breckenridge¹

2000

Professional Psychology: Research and Practice

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Provider profiling is a growing practice in organizations that supply or pay for health care, and escalating health care costs are likely to accelerate this trend. First developed for general medical settings, profiling systems now challenge practicing psychologists to meet ostensibly objective, scientific standards of care.The most advanced approaches compare provideis on a "level playing field" statistically adjusted for variations in the "illness burden" of their patients. Profiling psychological practice, however, requires specialized new tools and more sophisticated analytical methods than have typically been used. This article provides a practical overview of provider profiling, emphasizing related developments in health care policy that are perhaps less familiar to practicing psychologists. Potential pitfalls confronting professional psychology are discussed, and points for advocacy are suggested.Escalating costs of health services have fostered the rapid proliferation of managed care. In turn, the growth of managed care has led to the routine, intensive scrutiny of provider practice patterns as a primary cost-containment strategy-a strategy that has fundamentally altered the provider-payer relationship (Physician Payment Review Commission, 1992). Although the debate over provider profiling has focused on applications in primary and general medical practice, psychologists, psychiatrists, and other mental health practitioners are nonetheless subject to the same economic and competitive pressures that have inspired vigilant attention to others' behavior. As with many influential developments in health care policy and practice, however, profiling has received scant attention in the mental health professional literature.The motivations underlying profiling and the ways in which it has been implemented and interpreted have important ramifications for the mental health community, both as matters of public policy and as private concerns of individual practitioners. As programs to track services become more sophisticated, the poten-JAMES N. BRECKENIUDGE received his PhD from the University of Houston.

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Perceived Need and Receipt of Outpatient Mental Health Services

Rabinowitz

Gross

Feldman

2003

Journal of Ambulatory Care Management

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The finance and provision of care have been suggested as variables that affect the utilization of mental health services. This study compared perceived need and receipt of outpatient mental health services in a staff-model health maintenance organization (HMO) and in three HMOs with preferred provider organization (PPO) arrangements. A national random phone survey (n = 1,394) of perceived need for and receipt of mental health assistance was conducted in Israel in 1995. Health care is provided by four HMOs that differ in mental health benefits, utilization management (i.e., prior authorization and referral requirements), and availability of mental health services (i.e., pool of providers and geographic dispersal). About one-quarter of the respondents had perceived a need for help at some time in their life. Significantly fewer respondents from the HMO with a small pool of providers got help (20%) than respondents from the other HMOs, which had almost identical rates of obtaining care (40.3%, 37.3% and 40.3%). Providing generous outpatient mental health care benefits does not appear to increase the proportion of persons in need who get help. However, severely limiting the availability of services does reduce the proportion of persons getting care. Implications for regulating insurers are discussed.

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Mental Health and Managed Care

Cited by 7 publications

References 41 publications

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape

Provider profiling: What works for medicine works for mental health?

Perceived Need and Receipt of Outpatient Mental Health Services

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