Psychology's response to managed care.

Abstract

Managed care has had a significant impact on the field of psychology. In this article, a former president of the American Psychological Association and an early career psychologist discuss how managed care has affected the practice of psychology, the training of psychologists, and the perception of psychotherapy. They also review how organized psychology has responded to managed care and provide some insights on the future of psychology as it relates to managed care.

Therapeutic process in the context of third party determined time limits

“…Psychological problems in time‐limited treatment were more likely to be perceived in terms of symptoms. Systems of managed care may change the self‐perceived role of the psychologist to be more directive and less client‐centred (Cantor & Fuentes, 2008). In the present study, psychologists expected to utilise increased directiveness as a tool to ensure adequate therapeutic gains.…”

“…Psychological services are increasingly provided within a context in which third party payers impose limits on the number of therapy sessions available to the client and the therapist. Managed care is a notable—and controversial—context in which time limits on therapy may be externally imposed by third parties such as health insurers (Cantor & Fuentes, 2008; Rupert & Baird, 2004). In such a context, the length of therapy is “neither likely to be determined by the practitioner nor by someone directly involved with the client” (Bor, Gill, Miller, & Parrott, 2004, p. 186), calling into question the extent to which the needs of clients themselves are a determining factor in the length of therapy (Lambert, 2007).…”

“…'s (2006) qualitative study; many felt “compelled” to focus on superficialities and to use treatment approaches they believed to be ineffective. Psychologists may also become more directive when working within imposed time limits in managed care settings (Cantor & Fuentes, 2008). Consistent with these findings, approaches such as cognitive behaviour therapy (CBT), solution‐focused approaches, and brief strategic therapy are recommended in such settings because of their primary focus on symptom reduction (Cushman & Guilford, 2000).…”

Quality Improvement in Behavioral Health

“…Additional concerns have also been raised in the literature including ensuring protection of the rights of patients, particularly as it relates to safeguarding confidentiality of patient information while adhering to HIPAA laws (APA, 2009 ;Cantor & Fuentes, 2008 ;Hermann & Palmer, 2002 ). Moreover, providers have expressed concerns that QI programs will be used to punish clinicians by linking pay with performance Valenstein et al, 2004 ), and as an unintended consequence lead providers to treat only the more "easily treatable" patients (Bachman, 2006 ).…”

“…The challenges in developing rigorous QI programs are notable and require ongoing examination; yet, it may be that it is psychologists themselves who are uniquely qualifi ed to develop and participate in QI processes that address these challenges Cantor & Fuentes, 2008 ;Johnson & Shaha, 1996 ;Sanchez & Turner, 2003 ). Although the depth and breadth of one's training may vary by program, doctoral-level professional psychologists receive signifi cant training in both clinical skills and service delivery, and research methodology and program evaluation (APA, 2013 ).…”