Psychologists, Resist Managed Care! Comment.

Comments on the article by Sanchez and Turner (see record 2003-03405-005) examining the implications for practice and training in psychology in the era of managed care. The current author, having had direct experience with the model of primary medical care and behavioral care interface that Sanchez and Turner seem so enthusiastic about, warns of several shortcomings. The author likens the psychologists role in managed care to a form of assembly-line practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed Care: Implications for School Psychology. Comment.

Comments on the article by Sanchez and Turner (see record 2003-03405-005) examining the implications for practice and training in psychology in the era of managed care. The current author states that Sanchez and Turner should be commended. Their article amplifies and clarifies critical issues psychologists must consider while practicing within an era increasingly shaped by health insurance policies and practices. Nevertheless, the author feels that several intriguing facets of managed care were not highlighted. Discussion focuses on the impact that reimbursement and managed care is having on school (and clinical) psychologists. The author points out that it is unknown to what extent managed care may (and has) altered psychological services delivered by school psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging Patterns of Practice in the Era of Managed Care: Reply.

Responds to the comments of Crespi (2004), Suarez (2004), and Salyer (2004) concerning the authors' original article (see record 2003-03405-005) examining the implications for psychological practice and training in the era of managed care. In response to Crespi, the authors agree that school psychology is an important area of practice, given the contention that schools are responsible for providing 75% of mental health services to children. Reimbursement within educational contexts was not reviewed, largely because the relevant information was not available within the literature. However, the authors encourage efforts to continue to disseminate information regarding a largely unexplored issue that may have important implications for children. The authors also agree with Suarez and Salyer that the value of direct and personal experience should not be overlooked. Those in private practice may indeed face challenges in dealing with managed care with which the current authors do not have personal experience. However, it should be clear that the aim of the original research was to critically evaluate the current literature and to determine what is known and unknown about managed care and to point out alternative views and systems worthy of consideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Breaking free of managed care: A step-by-step guide to regaining control of your practice.

Reviews the book, Breaking free of managed care: A step-by-step guide to regaining control of your practice by Dana C. Ackley (see record 1997-97500-000). This book provides a practitioner's blueprint for moving from dependent (on managed care) to independent practice. It is organized around three major themes: 1) dealing with managed care; 2) the business of managed care-free therapy; and 3) the array of psychotherapists' services. The reviewer points out that the author tends to overlook some problem areas in psychotherapy. In addition, he takes some of his own skills as a doctoral-level clinical psychologist for granted and fails to appeal to practitioners with minimal training or expertise. However, overall, the reviewer believes that this is a highly enjoyable and practically useful book which provides some guidance to practitioners wanting to "break free from managed care." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Constructing managed care, constructing brief therapy.

Comments on the article by P. Cushman and P. Gilford (see record 2000-05933-002). The author appreciates the questioning of managed care's use of positivism and "objective scientism" as well as a recognition of its focus on "instrumentality, efficiency, and conformity", but argues that brief therapy and managed care are not synonymous. The author sees many problems with managed care, but also sees the need for fiscally viable and clinically sound ways to provide broad services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practicing psychology in the era of managed care: Implications for practice and training.

Beginning with the HMO Act of 1973, managed care, a system for controlling health care costs, rapidly expanded and gained influence as the main vehicle for health care delivery in the United States. Implementation of managed care principles in the mental health arena has generated much debate, particularly with respect to issues of quality of care. The authors briefly trace the development of managed care and evaluate its impact on the practice of psychology. The extant literature is reviewed with specific attention to issues of quality of care, confidentiality of patient information, and shifting practice patterns of clinicians. Finally, the future of professional psychology within the context of managed care is examined, and the implications of newly created mental health roles for practitioners, training programs, and organized psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology's response to managed care.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The "frisson" benefits of managed care.

Comments on the article by Anonymous (see record 1995-33982-001) which, in presenting the hidden benefits of managed care, offers a spoof on the managed care debate. The current author applauds the article for its comic relief and its way of turning the qualities of managed care that are generally considered intrusive into positive attributes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed Care and the Independent Practice of Psychology.

How has managed care impacted the independent practice of psychology? The present article reports on data from 2 national surveys (from 1996 and 2001) that address this question. Both surveys indicated that managed care was a source of stress, with external constraints, paperwork, and managed care reimbursement being the most highly rated stresses. These stresses had not increased in the 5 years between surveys, and the most recent survey suggested that, overall, psychologists did not report high levels of burnout. However, in contrast to respondents with low managed care involvement, respondents with high managed care caseloads worked longer hours, had more client contact, received less supervision, reported more negative client behaviors, experienced more stress, were less satisfied with their incomes, and scored higher on emotional exhaustion. Implications for burnout are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prisoner of managed care?

Comments on the article by Anonymous (see record 1995-33982-001) which, in presenting the hidden benefits of managed care, offers a spoof on the managed care debate. The current author likens the article's conceptualization of managed care to his own experiences as a prisoner of war in World War II. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who has the "relationship" in managed care?

Comments on R. E. Patricelli and F. C. Lee's article (see record 83-35320) describing innovations in managed behavioral health care. The author calls attention to a possible overapplication of the term "continuity of care" in the Patricelli and Lee article, when describing what is more certainly a 'continuum of care". Even the best managed care techniques do not come close to providing continuous, personal contact. It is argued that the difference between a managed continuum of care and continuity of care lies at the crux of the care delivery problems faced by many mental health care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarification on Psychological Treatments and Psychotherapy.

In this article, the author responds to a set of comments (see record 2005-11834-009; 2005-11834-010; 2005-11834-011) on his original article, "Psychological Treatments" (see record 2004-21168-001). The author responds to each comment. Hal Arkowitz (2005) misread the proposed distinction between "psychological treatments" and "psychotherapy" by presuming that the author was implying that the former is evidence based and the latter is not. Kwekkeboom et al. (2005), representing the nursing profession, noted quite correctly that nurses often deliver psychological treatments on the frontlines of primary care and are independently licensed to provide nursing services, including many approaches that could be categorized as "psychological." Ahmed and Boisvert (2005) agreed that psychological treatments are a core strength of psychology and also go on to provide additional interesting examples and to identify other areas of practice in which psychologists may be uniquely qualified. Overall, the author notes that only certain well-defined pathologies will be included in any health care system, and treatment for these conditions will increasingly need to be based on evidence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Psychologist supply, managed care, and the effects of income: Fault lines beneath California psychologists": Erratum.

Reports errors in the original article by D. Pingitore et al (Professional Psychology: Research and Practice, 2001, Vol 32[6], 597-606). In the first paragraph on page 601, lines 5-10 should read: "Net income for psychologists aged 40-54 years was significantly greater than for psychologists 39 years and younger (pt test for income differences by age group should be pp>.05). (The following abstract of this article originally appeared in record 2001-05464-006.) Data from the 2000 California Survey of Psychological Practice (D. Pingitore, R. Scheffler, M. Haley, T. Sentell, & D. Schwalm, 2001) were used to measure psychologists' income variation associated with demographic characteristics, managed care participation rate, and mental health workforce supply concentrations. A 10% increase in the supply of psychologists in a psychologists' market of practice resulted in a $1,749 reduction in income compared with a $1,330 income reduction due to a 10% increase in managed care participation... (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A perspective on the nation's antitrust policies: Implications for psychologists.

In response to significant change in the health care market, federal antitrust agencies recently examined their past policies and future directions for antitrust law enforcement in the health care industry. This article reviews how the federal antitrust laws have been used to both aid and restrict the practice of psychology, psychologists' dealings with managed care, and the limits of antitrust law enforcement efforts. Finally, we argue that narrowly crafted antitrust reform would provide practicing psychologists and other health professionals with some degree of countervailing bargaining power in their negotiations with managed care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anonymous ethical investigations?

Comments on the article by Anonymous (see record 1995-33982-001) which, in presenting the hidden benefits of managed care, offers a spoof on the managed care debate. The current author contends that this same material has been previously presented in the Fall issue of Division 42's newsletter, The Independent Practitioner (B. Arnold, 1994). It therefore appears that either Anonymous (1995) has plagiarized Arnold (1994), or that Arnold has engaged in inappropriate duplicate publication under the assumed name of "Anonymous." In light of these facts, the current author wonders if and how the American Psychological Association (APA) Ethics Office will investigate this issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

No right to protection of anonymity.

Comments on the article by Anonymous (see record 1995-33982-001) which presents the hidden benefits of managed care. The current author takes offense that the author's name was withheld, as this prevents assessment of the author's credentials and possible political agenda. The current author also contends that the views expressed by Anonymous are "demeaning and offensive" because of its provocative and self-satisfied tone in the face of the unchecked abuses and destructive effects of the managed mental health industry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to "All That Glitters Is Not Always Gold: Medical Offset Effects and Managed Behavioral Health Care".

Comments on an article by J. S. Fraser (see record 1996-00461-003) regarding managed behavior health care offset effects in marketing managed behavioral care services. Previous criticism of medical cost offset, problems in Fraser's study and report, and the relationship of research to public accusations against Medco (Fraser's funding source) are discussed. The present author concludes that Fraser's article does not address the stated goal of clarifying unrealistic expectations that led to the Wall Street Journal exposé. All of Biodyne's contractual failures alleged in the Wall Street Journal article remain unchallenged by Fraser's examination of medical cost offset. It is argued that because the published article contains numerous errors, questions must also be raised about the accurate collection and interpretation of raw data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional psychology in a new era: Practice-based evidence from California.

The California Survey of Psychological Practice provides comprehensive data on patient case mix, treatments, practice settings, and payment sources using a representative sample of psychologists. These psychologists practice in diverse settings and continue to deliver traditional psychotherapies. California psychologists' treatment of persons with private insurance highlights the profession's public health contribution by improving the functioning of employed persons and their families. Despite high managed care enrollment among Californians, these psychologists demonstrate wide variability in managed care participation. The authors compare the findings to prior surveys among psychologists and discuss the findings in relation to trends in psychological practice and public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delivery of mental health services in the changing health care system.

Comments on the anonymous article, "Hidden benefits of managed care" (see record 1995-33982-001), in which the author expresses concern that managed care organizations are making decisions on the basis of economics and not the well-being of the patient. B. Miller and L. Farber empathize with the author's concerns, but contend that, if structured properly, HMOs can become the vehicle for the reengineering of mental health services that will produce the best patient outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)