Legal liability and managed care.

In attempts to reduce the cost of mental health treatment, health insurers are turning to mechanisms for intensive oversight that fall under the rubric of managed care. These approaches have implications for the potential liability of clinicians and managed care entities. Clinicians may be confronted with legal duties to appeal adverse decisions, to disclose the impact of managed care on patients' treatment, and in some circumstances, to continue treatment after payment has been denied. Managed care entities are being held to duties to conduct review in a reasonable fashion, and may also have a duty to disclose the limitations managed care may place on patients' access to treatment, and to select appropriate providers of care. The law in this area is in an early stage of development and is likely to be refined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regulatory trends in workers' compensation managed care

The authors discuss various managed care arrangements in workers' compensation and present a valuable chart that summarizes the managed care policies of each state and the district of Columbia and links the policies to their regulatory environments.     

A new analysis of life-span age trends in visual illusion.

Tested the magnitude of the over- and underestimated portions of the Ebbinghaus (Titchner circles) illusion in 688 Ss ranging in age from 5 to 70 yrs. Results indicate that the overestimated portion decreases while the underestimated portion yields increasing illusory distortion as a function of age. Both configurations produced nonlinear age trends. These results suggest that reports of inconsistent age trends in illusions may be the result of combining increasing and decreasing age functions found in some components of the same illusion configuration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medicaid managed care and community providers: new partnerships

Growing enrollment in managed care plans among Medicaid recipients represents a new market for these plans but presents challenges to those providers that traditionally have served this population. To continue serving Medicaid patients, community-based providers must develop contracts or other types of partnerships with Medicaid-contracting health plans. This paper reviews the challenges to such collaboration and discusses the practical issues that plans and community-based providers must resolve to develop productive working relationships. Keys to successful collaboration are identified. Ways in which federal and state governments can help the collaborative process are suggested.     

Negative discipline in families: A multidimensional risk model.

The relation between parental discipline and family functioning is well documented. Less well understood are the factors that influence parental discipline. In this study, a multidimensional model is introduced in which known correlates of negative discipline are integrated into a single conceptual framework. These correlates, which are considered to be risk factors, include traditional gender role values, parental antisocial personality characteristics, interspousal conflict, financial strain, and child gender. Separate analyses were conducted for mothers and fathers who expressed low and high levels of gender role traditionalism. Results indicate that the model does predict negative discipline in highly traditional mothers but not in other groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hidden benefits of managed care.

It seems to me we spend so much time complaining about managed care that we never get to talk about managed care's hidden benefits. I call them hidden for just that reason: They are never spoken of, written about, or even mentioned in passing. I have been guilty of that one-sidedness, and so it seemed only fair that I take the opportunity to correct the imbalance. Consequently, I will present here four of the hidden benefits of managed care: (a) technical assistance and education, (b) opportunities for socializing, (c) the promotion of interdisciplinary collaboration, and (d) free supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dilemma of managed care.

Responds to the article by L. S. Brown (see record 84-21642) regarding managed care and false memory movement issues in social justice-oriented psychology. The current author argues that Brown abandoned psychologists be declining to think through how responsible and ethical people can work their way out of binds. Buchholz also contends that a greater call to unity and action among psychologists is needed to fight the dehumanizing and threatening effects of the HMOs and insurance companies on mental health service delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of informal care is multidimensional.

Purpose: To demonstrate that assessing quality of informal care involves more than merely determining whether care recipient needs for assistance with activities of daily living (ADLs) are routinely satisfied. We investigated the extent to which potentially harmful behavior (PHB), adequate care, and exemplary care (EC) are empirically distinct dimensions of quality of care. Design: 237 care recipients completed the quality of care measures, and their caregivers completed psychosocial measures of their own depression, life events, cognitive status, and perceptions of pre-illness relationship quality. Results: Although PHB was moderately related to EC, adequate care was not associated with PHB and was only slightly related to EC. Psychosocial variables were not related to adequate care but were differentially associated with PHB and EC, providing additional evidence for the distinction between these measures of quality of care. Conclusions: ADL assistance can be adequate in the presence of PHB and/or the absence of EC. Declines in EC may signal increases in PHB, independent of adequacy of care. These findings produce a brief, portable, and more comprehensive instrument for assessing quality of informal care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considerations for ethical practice in managed care.

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research, practice, and managed care.

Examines the relationship between practitioners, researchers, and managed care. Managed care systems' basic purpose is to conserve as much as possible the health care dollar, and to provide rationale for the equitable distribution of public funds. Despite evidence that psychotherapy is an effective treatment, this well-documented conclusion continues to be assailed. Research has been used as a tool for undergirding the rationing of therapeutic services. Similarly, the demand for treatment manuals has been met and treatment manuals have been shown to be of value, although the value is limited. In the same vein, time-limited forms of therapy can produce change, but such changes will in most cases be modest. The author notes that it is one thing to recognize that in the face of a shrinking health care economy professionals must accept more or less severe restrictions imposed on their activities. However, it is quite another to create the impression that brief or time-limited forms of psychotherapy are fully comparable or even superior to more intensive and extended forms. There is also reason to believe that well-trained experienced therapists are superior service providers. The need for greater tolerance and realism in accepting what psychotherapy can and cannot do is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychotherapist and the managed care setting.

This study represents a beginning effort to understand how alternative health care delivery systems affect psychotherapists and psychotherapy practice style. Professionals from various mental health disciplines employed in staff-model health maintenance organizations (N?=?43) served as interviewees. Therapists answered objective and semistructured questions about their work setting, "burn-out," graduate training, and the evolution of self and practice style. Although methodological limitations prohibit meaningful and valid generalizations, the results suggest that alternative health care settings may serve as catalysts by creating an atmosphere that shapes and influences the therapist to develop more eclectic, short-term, problem-focused psychotherapy practice habits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)