Contracts: A primer for psychologists.

Most psychologists in private practice will at some point consider contracting with a managed care organization (MCO) as a part of joining that MCO's provider panel. Such contracts are structured to advantage the HMO, and there are a number of specific contractual features that psychologists have often found problematic. This article offers a review of issues and contractual features that psychologists may wish to consider when contracting with MCOs and offers recommendations for alternative contractual arrangements that may be helpful for psychologists to negotiate when possible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Forward and reverse genetic approaches to synaptogenesis

The growing need for information about managed care and for the use of managed care organization (MCO) members in clinical and health services research requires research capability within MCOs. To learn the extent to which such capability exists, we conducted a survey of readily identifiable MCO research programs. Responses were obtained from twenty of twenty-three eligible organizations. Although there is great variability in size, these organizations have a collective budget of $93 million, more than 158 career researchers, and extensive research infrastructure and applied research activities.     

Managed care, school health programs, and adolescent health services: opportunities for health promotion

The rapid expansion of managed care creates opportunities and dilemmas for those involved in school health and adolescent health promotion. Managed care organizations (MCOs), public health agencies, and school and adolescent health providers share certain common goals and priorities including an emphasis on prevention, cost-effectiveness, and quality of care--and a willingness to explore innovative approaches to health promotion and disease prevention. However, MCOs often face conflicting challenges, balancing the goals of cost containment and investment in prevention. In considering support for school health programs, MCOs will be interested in evidence about the effectiveness of services in improving health and/or reducing medical expenditures. Mechanisms for improving prevention efforts within MCOs include quality assurance systems to monitor the performance of health plans, practice guidelines from professional organizations, and the contracting process between payers and health care providers. Development of partnerships between MCOs and schools will be a challenge given competing priorities, variation in managed care arrangements, structural differences between MCOs and schools, and variability in services provided by school health programs.     

Accountability for quality in managed care

BACKGROUND: It is often difficult to understand where responsibility lies for monitoring and improving quality in managed care. From 1996 through 1998 a group of individuals convened by the Institute of Medicine's (Washington, DC) National Roundtable on Health Care Quality developed a model of accountability for the quality of care provided by managed care organizations (MCOs). Each of three overarching forms of accountability (professional, market, and regulatory) has a set of tools for imposing accountability and-because accountability relationships are not self-enforcing-sanctions for failures of accountability. PROFESSIONAL ACCOUNTABILITY: Fiduciary relationships in medicine are an essential part of any quality accountability mechanism, and it will be important to maintain the strength of the professional model in the changing health care system. Yet it is not easy to preserve the strength of the professional model in an MCO environment in which professionals are not dominant, and there is likely to be increasing pressure to weaken their autonomy. MARKET ACCOUNTABILITY: The primary assumption of market accountability is that consumers will select options based on perceived value to them and will make new choices based on their information and experience. Market accountability requires choice among competing providers and information to inform choice. In health care, however, individuals rarely have the information they need and often do not have choice. Accountability for quality generally has not been a major feature in contracts. REGULATORY ACCOUNTABILITY: There is a widespread perception of defects in a market-based health care system. Many believe there is a need for a regulatory structure to correct market failures. The use of regulation to impose accountability for quality requires that a regulatory framework, penalties for violations, and effective enforcement mechanisms are all established. PUBLIC GOODS: The model of accountability for quality in managed care does not promote public goods such as education, research, public health, or care for the uninsured. Indeed, the locus of responsibility to the community when markets fail to supply these public goods is controversial. Nevertheless, such responsibility should be considered by MCOs and policy makers. COLLABORATION TO IMPROVE QUALITY OF CARE: Given market-driven models of health care financing and delivery, it might be feasible and desirable to encourage collaboration among MCOs to improve quality, whether at the national or local market level. The health professions in general, and the medical profession in particular, are and must be accountable to society for providing leadership in the development of knowledge about effective medical care, in defining high-quality care, and in advocating for and improving the quality of care. CONCLUSION: Establishing effective accountability for quality involves multiple entities and many different kinds of accountability relationships. The three forms of accountability interact, and all operate at once.     

Myocardial infarct and geomagnetic disturbances: analysis of data on morbidity and mortality

BACKGROUND: There is increasing evidence that the most effective way to improve delivery of preventive services in primary care is to establish organized preventive service systems. This study tests the hypothesis that a managed care organization (MCO) can help its contracted private primary care clinics to develop such systems. METHODS: Forty-four primary care clinics contracting with two large MCOs were randomized to a comparison (C) or an intervention (I) group. Group (I) clinic team leaders received training plus ongoing consultation and networking. Personnel at all 44 clinics completed surveys prior to and at the end of the intervention to measure adoption of the improvement process and the prevention system. RESULTS: All 22 (I) clinics identified teams that appeared to follow the seven-step improvement process. The mean numbers of system processes were identical at baseline, 11.2 (I) vs 12.1 (C), while after the intervention this had changed to 25.8 in (I) clinics vs 11.3 in (C) (P = 0.022). CONCLUSIONS: With training and assistance, interested primary care clinic teams will establish functioning CQI teams that will produce a substantial increase in the presence of functional prevention system processes. Whether this change is sufficient to increase the rates of preventive services remains to be documented.     

Focus groups reveal perils and promises of managed care for nurse practitioners

Decades of practice and research suggest that nurse practitioners (NPs) provide cost-effective and high-quality care. Managed care's emphasis on prevention and cost savings led some policy makers to view NPs as a way to meet the need for primary care providers. However, access to and utilization of NPs has increasingly been controlled by managed care organizations (MCOs) through their selection of providers for primary care panels. This study employed qualitative methodology to examine NPs' experiences with MCOs. Three focus groups, comprising 27 NPs in New York and Connecticut, revealed NPs' mixed reactions to managed care and a range of sentiments regarding NPs' efforts to be listed as primary care providers. The results reflected NPs' concerns about their perceived "invisibility," as well as their sense of "invincibility" in the ways in which NPs are responding to the barriers posed by MCOs. They identified barriers to, as well as ways to facilitate, being listed by MCOs, and described the importance of NPs working individually and collectively in negotiating with MCOs.     

What is proper cancer care in the era of managed care?

Managed care and proper cancer care need not be mutually exclusive entities. Managed-care organizations (MCOs) that are committed to patients and society should have the following characteristics: accountability for results, cost containment, measurement of outcomes, health promotion and disease prevention programs, resource consumption management, emphasis on primary care, and continuous quality improvement. Whether these commitments are upheld depends on when and with whom the MCO contracts to provide care and which medical and quality assurance protocols it follows. If proper cancer care is to become a reality in the managed-care era, the oncology community must take a proactive stance. Oncologists must provide the market with an appropriate, efficient disease management plan for cancer. In concert with MCOs, the oncology community must define and, through partnerships, promote the seamless integration of proper cancer care. Patients and advocates should insist that MCOs' quest for efficiency allows for flexibility to address individual patients' circumstances.     

Advanced marketing strategies to build the esthetic dental practice

Esthetic dentistry is truly a major part of the future of the fee-for-service practice. There are still many patients who seek high-quality elective care and these individuals need to be swayed to make an initial appointment with you. Whether you reach them through your present patients or through outreach to the community, the important key is your method of handling each of these patients as they join your practice. Customer service needs to be stronger and more obvious than ever before in order to differentiate your practice from others and to attract more referrals. The days of waiting for patients to arrive have clearly come to an end. Managed care and a decline in the need for traditional services has eroded a significant component of the dental market. When you combine that with the realization that only 50% of the population visits the dentist even once a year (and far less in many countries outside the United States), then it becomes obvious that the total available market for the elective services of esthetic dentistry has declined. Esthetic dentistry programs must be better defined, with an ongoing focus to educate present patients and to attract new patients. As I state in my seminars, I firmly believe that any practice today can still be highly successful. I do not feel that I will be making that statement three to five years from now. The time to begin positioning your practice for future growth of esthetic dentistry is now. As managed-care programs increase, it will become more difficult to turn around a declining practice. Having a quality marketing program already in place will make the difference for your esthetic practice. The new patient phone call is critical. It is there that you will begin to help patients understand fully the overall attitude and policies of your office. Successful management of new patients is to win their trust by giving them ultimate customer service while convincing them to fit your present system and schedule. When a new patient calls the practice, you want to get them scheduled within a reasonable time frame while their motivation is still positive. Remember, you only get one first chance to make a great impression. Each office should decide which questions are appropriate to ask. The front desk coordinator should ask these questions calmly and clearly so that the new patient has an opportunity to answer them without feeling that they are going through the inquisition. At the same time, the more information you have about this patient, the easier it will be to gain treatment acceptance because of your understanding of the new patient's needs. Many offices will ask new patients how they came to choose their particular office. Since many practices gain new patients from existing patients, it is appropriate to know when this has occurred and properly thank the referral patient. By thanking the patient who referred the new patient, you will encourage further referrals.     

How the principles of geriatric assessment are shaping managed care

In traditional geriatric medicine, comprehensive assessment is considered crucial to the care of frail older patients. The principles of geriatric assessment--identifying high-risk patients and targeting them for preventive interventions--are also practiced by managed care organizations (MCOs). Self-reported health surveys and administrative data are two methods used by MCOs to identify members at high risk for adverse health outcomes and functional decline who may benefit from geriatric case management. For a successful partnership with primary care physicians, it is very important that geriatric care managers should be knowledgeable in the principles of geriatric medicine.     

Dental ethics in the culture of the 90s: from creed to action

There are six proven ways to integrate a healthcare financing program into your practice. Challenge yourself to maximize your financial service. You will see more people receive valuable care. You will grow your practice. You will reap financial reward. You will provide more of the quality dentistry that makes the art and science of your profession a joy.     

MSO case study provides insights for Michigan MDs

How do you build a successful physicians' management services organization? MSMS, the AMA and several other medical societies set out a few months ago to learn the answers to this question. What we learned will have important ramifications for the MSO the MSMS House of Delegates has directed your state society to create. The House of Delegates believes your own MSO will provide you with the best possible services and support as you, our members, move toward success in the managed care arena.     

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)     

Building healthier communities in a managed care environment: opportunities for advanced practice nurses

Two paradigm shifts are occurring in health care: managed care and community partnerships. The distinct principles and trends of each paradigm are certain to determine the future practice of advanced practice nurses (APNs). The impact of managed care and community partnerships will affect the resource management, clinical decision making, and time management of APNs. Concomitantly, APNs will have opportunities to influence practice guidelines, individual and community decision making, cultural competence, and the cost-effectiveness of care in communities. Capitalizing on these opportunities will enhance the value of APNs to their managed care plan employer and their community.     

Practice management applications

Even though you will never find a dental management system that will do exactly what you want, there are a tremendous variety of systems out there with some incredibly powerful features. Look for a system that can handle most of the tasks you need. Keep your eye on other technologies that you may want in your practice. The system you purchase now should be able to handle whatever technologies you decide to add on in the next 3 to 4 years. Once you have made the decision to purchase, the transition to automated management begins. It will be necessary to train you and your staff on how to use the system. Depending on the system chosen, it may be necessary to adjust your management strategies in a number of areas to take advantage of the system's features. This may cause a few adjustment problems at first, but things will work out with a little time and effort. In the next few years, advances in technology integration will allow you to seamlessly blend practice management, voice charting, intraoral cameras, CAD/CAM, lasers, EDI, video imaging, etc., into a single potent system for complete clinical and practice management. A dental practice management system is the first step to realizing that future. Shop wisely and invest your time in learning the terminology and techniques of automated information management.     

Pencil and paper: the simple solution to getting the numbers you need to effectively manage your practice

Once you have mastered the basics by going through the monitoring exercise once or twice, you will find it takes little time and effort to start finding out just where your practice stands. You only solve a problem after you have found out that there is one and you might find that this simple monitoring exercise shows you areas of your practice where a little attention from you will pay big dividends. Monitoring is like a fine wine: it improves with age. As you begin to compile more and more months of data, you will be able to start comparing this month's performance with last month's, or this quarter with last quarter, this year with last year. One of the most useful things monitoring will do for you is to allow you to compare your practice's performance with that of other practices. Averages, norms, and performance survey results are to be found in a range of practice management publications. Using your monitoring information in this comparative way helps you to identify those areas in your practice management that are holding you back from achieving your true potential. This lets you focus your management time and effort on the truly important issues, which, when solved, will help you turn your practice into a less stressful, more enjoyable, and more profitable place to work.     

Managed Care Viewed From the Ivory Tower: 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 believes that Sanchez and Turner presented an overly optimistic picture of behavioral managed care based, in part, on various misconceptions. Discussion focuses on examining/correcting those misconceptions. The author states that it is understandable that a graduate student and a university professor, neither of whom has worked extensively in private practice, would have misconceptions about how managed care works and its impact on the profession. What the author finds disconcerting, however, is that Sanchez and Turner's article, with a number of misperceptions, got published when 90% of the articles submitted get rejected. (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)     

Home healthcare nursing in the managed care environment. Part II. The impact on clients and professional nurses

Part I, published in last month's issue of Home Healthcare Nurse, provided information about managed care and health maintenance organizations (HMOs). This article, Part II, presents an overview of the history of home healthcare nursing, the results of a purposeful sample, and interviews of home care nurses. Interviews were conducted to determine how nurses perceived the impact of managed care on their clients and nursing practice. Conclusions are presented in terms of emergent categories gleaned from the interviews. Recommendations for the continued growth and advancement of professional nursing in the context of managed care are given.