The importance of professional psychology: A view from managed care.

Abstract

Over the past 15 years, the development of managed health care has led to changes in the way that psychology is practiced and in the ways that quality is measured in the health care system. In this article, the current status of population-based Health Plan Employer Data and Information Set quality metrics are reviewed. Many medical measures of quality have improved in the past 5 years, whereas behavioral health measures have shown only modest improvement. Reasons for this finding are discussed, and it is suggested that quality of care for individuals and populations could improve as psychology adopts evidenced-based practice and clinical practice guidelines.

Quality improvement and outcomes in the future of professional psychology: Opportunities and challenges.

“…The use of patient-reported outcomes is a key aspect of quality improvement that is directly relevant to care provided by outpatient practitioners. Our treatment of this topic as a key part of quality is analogous to the argument made by Bobbitt (2006) about the role that clinical treatment guidelines play in individual treatment and population health care. Treatment guidelines are summary documents that provide guidance to clinicians and should be consistent with population metrics.…”

Comparison of public/private health care insurance parameters for independent psychological practice.

“…Some psychologists, who do not themselves work as independent practitioners, have focused on positive relationships between psychology and managed care. As illustration Bobbitt (2006), a psychologist in the employ of a managed care corporation, stressed the positive role psychology could play in the development of evidence-based practice guidelines and behavioral health effectiveness-of-care measures for managed care accrediting organizations. Sanchez and Turner (2003), a graduate student and an academic respectively, stressed the formation of newly created mental health roles for psychologists under managed care, especially in partnering with primary health care physicians.…”

“…Examples of quality standards for the National Committee for Quality Assurance (NCQA-www.ncqa.org) that claims leadership in the behavioral health plan accreditation field include: “Are organization practitioners located throughout the service area?” and “Are criteria and procedures for approving and denying care clearly documented?” Effectiveness-of-care data sets are collected from health care claim review to allow comparisons among companies, but the NCQA data set has only three behavioral effectiveness-of-care measures: (a) follow-up after psychiatric hospitalization; (b) antidepressant medication management; and (c) follow-up care for children prescribed attention deficit hyperactivity disorder medication. These measures, that virtually ignore the quality of mental health services offered by providers who are not psychiatrists, have shown little improvement in the past few years, in contrast to many medical effectiveness-of-care measures (Bobbitt, 2006). Accrediting agencies lack a legal enforcement mechanism and penalties for non-compliance with minimum standards are limited to loss of accreditation.…”

Psychology's response to managed care.

“…We would be remiss if we did not note that there are some psychologists who see the metaphorical silver lining. Bobbitt (2006) asserted that managed care has encouraged certain trends. For example, he contended that managed care has contributed immensely to the development and implementation of “quality improvement processes” and to the overall assessment of the health care system.…”