Outcomes management, reimbursement, and the future of psychotherapy.

Abstract

Lack of money is no obstacle. Lack of an idea is an obstacle.-Ken Hakuda First, let us state the obvious: Psychotherapy is a business. It is a purchased service-whoever pays for it believes that its benefits ate worth the ptice. Revenues to support the business of psychotheiapy come from multiple sources; foi a typical client, they are likely a combination of out-of-pocket expense and a subsidy provided by an employe!, health plan, governmental entity, or other oiganization oi institution (e.g., employet-sponsoied employee assistance program).Psychothetapy, as a service, is believed by many in the public-as well as employets, insuiance companies, health care plans, and various governmental entities-to successfully reduce disabling psychological symptoms. Psychotherapy is also thought to improve day-to-day functioning and relationships with family and otheis and even to offset medical costs. Among practicing theiapists, all of these benefits are so self-evident that it is almost an article of faith. It is obvious, howevei, that faith alone does not deteimine the value of psychotheiapy fot society as a whole (and, in particular, for those who fund the seivices).If the trend in reimbutsement rates for psychothetapy seivices is any indication ofthe stiength of society's faith in psychotheiapy, the future looks bleak in comparison with othei fotms of tieatments for psychological distiess 267

Preliminary Analyses of Three Measures of Grace: Can They be Unified?

“…In practice 10-15 items are commonly used. Mean item scores are reported so scores are independent of the number of items employed (Brown & Minami, 2009;Minami, Brown, McCulloch, & Bolstrom, 2012;Minami et al, 2008). For this study, a 14-item version formerly adopted by Western Psychological and Counseling Services was used.…”

Progress Monitoring in an Integrated Health Care System: Tracking Behavioral Health Vital Signs

“…Based upon our initial experience and in consultation with the third party vendor, we decided to use a nomothetic approach which would simplify administration (same measure for each patient at each visit) and we used items that the vendor had identified were sensitive to change in a wide variety of clinical conditions (i.e., global distress) and were also psychometrically valid. Severity adjusted effect size, a standardized method for determining change that takes into account case mix and symptoms severity (Brown and Minami 2010) was the measure used by the vendor to determine clinical significance of change across a patient population. The vendor also had a free standing web site which included raw scores on an individual basis, a graphical representation of the change in raw scores for individual patients, and severity effect change scores for population of patients on the provider, clinic, and organizational level.…”

The Moving Psychoanalytic Frame: Ethical Challenges for Community Practitioners

“…Insurance companies developed as a business and subscribers demanded that psychotherapy be included in the list of mandatory services covered by medical insurance (Brown & Minami, ). As this evolved, a cyclical, systemic pattern emerged in which greater demand for services required a broader range of providers (i.e.…”

“…As this evolved, a cyclical, systemic pattern emerged in which greater demand for services required a broader range of providers (i.e. psychologists, counselors, and social workers), while simultaneously stretching the coffers of the insurance providers who sought to place ever greater limitations on financial reimbursement, while meeting the demands of their subscriber companies (Brown & Minami, ). In addition, the rise of psychopharmacological interventions was now narrowing the psychiatrist's role to one of psychotropic prescriber, leaving the delivery of psychotherapy services increasingly within the purview of allied mental health professionals (Plante, ).…”

“…As the cost of in‐patient hospitalization continued to climb, and the effectiveness of in‐home psychotherapy in preventing such hospitalizations was increasingly shown to be effective, the era of OP had arrived (Brown & Minami, ). Best practices showed that cost savings occurred for insurance companies when clients were able to be seen in their homes instead of needing to be hospitalized.…”