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)     

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)     

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)     

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)     

Managed mental health care: The client's perspective.

Changes in psychotherapy services have been the focus of controversy between psychologists and the managed-care industry, yet too seldom have client preferences been directly heard in that debate. This study investigated consumer attitudes about the central elements of psychotherapy service delivery by 3 participant groups: self-pay clients, managed-care clients, and adults without therapy experience. Important differences of opinion were found among participant groups, yet results revealed that all 5 elements investigated were considered essential. Autonomy in treatment decision-making was ranked most important, followed by choice of therapist, copayment amount, limits to confidentiality, and ease of access to care. (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)     

Meeting U.S. Health Care Needs: A Challenge to Psychology.

Is there really a growing need for primary care psychologists? U.S. population health statistics reveal a great deal of variability in the care Americans receive and in their associated health outcomes. Members of minority groups, the inner-city poor, and rural Americans bear a disproportionate burden of ill health. The decreasing pool of primary care physicians is documented as well as is the growing pool of nonphysician primary care providers. The need to expand the nature of psychological interventions in primary care is examined, and change in the training of professional psychologists is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of Cognitive-Behavioral Treatment for Panic Disorder Versus Treatment as Usual in a Managed Care Setting.

Eighty clients enrolled in a managed care health plan who identified panic disorder as their primary presenting problem were randomly assigned to treatment by a therapist recently trained in a manual-based empirically supported psychotherapy (M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or a therapist conducting treatment as usual (TAU). Participants in both conditions showed significant change from pre- to posttreatment on a number of measures. Those receiving panic control therapy (PCT) showed greater levels of change than those receiving TAU. Among treatment completers, an average of 42.9% of those in PCT and 18.8% in TAU achieved clinically significant change across measures. The results are discussed with reference to the dissemination of PCT and other evidence-based psychotherapies to clinical practice settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology, the stalwart profession, faces new challenges and opportunities.

Psychology emerged as a profession following World War II, seemingly out of nowhere and against all odds, through the sheer grit and determination of its early clinical psychology doctoral pioneers, who recognized the economic importance of licensure and third-party reimbursement. After 2 or 3 decades of prosperity in which psychology became the nation's preeminent psychotherapy profession, professional psychologists ignored warnings of impending managed care and the biomedical revolution and have suffered an unfortunate decline in income. Once again healthcare is confronted with double-digit inflation, and draconian reimbursement measures are being put into place that will impact psychological practice. Practicing psychologists need to heed these harbingers and deflect their negative effects while taking advantage of their potential opportunities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral medicine: 2002 and beyond.

This article highlights future directions for research and practice in behavioral medicine. Topics addressed include social and environmental issues, the role of technology, translational research, improving and developing interventions, and professional training and retraining. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conflict across organizational boundaries: Managed care organizations versus health care providers.

This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Editorial: What will the 21st century bring? An emphasis on quality care.

Day-to-day concerns frequently take precedence over abstract concepts for psychologists practicing in the United States. However, traditional mental health services are a subset of the more generic health care environment, and changes in this environment will eventually affect the daily practice of mental health practitioners. For a profession to continue to mature and thrive, leadership must be aware of and capitalize on relevant national and international changes. In the 21st century, advances in technology and communication will affect the quality of services and will likely result in increased stress for practitioners and patients. This article reviews developments within the American Psychological Association and explores both current and potential roles that will shape the future of professional mental health practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists: The Backbone of the VA Health Care System.

Veterans returning from Iraq and Afghanistan are presenting in large numbers with serious mental health needs. Chairman Akaka addresses this concern and the role of the Department of Veterans Affairs in caring for those in need of mental health services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transforming Mental Health Care for Children and Their Families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crossing the Quality Chasm in Behavioral Health Care: The Role of Evidence-Based Practice.

The concept of evidence-based practice (EBP) is one receiving increasing attention from providers, managers, payers, and regulators of care, yet practical guidelines for professional psychologists who may be interested in incorporating EBPs into their own work settings are not available. The author explores the pragmatics of EBP adoption within the broad context of quality problems in American health care, particularly as described in a heralded 2001 publication by the Institute of Medicine. Concrete suggestions are offered to help practitioners locate EBP resources for specific clinical problems, use an evidence hierarchy to infer "best practices," address the science-to-service management challenge, and generate outcomes data and feedback loops to continuously improve clinical effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Foundations for Medical Care.

Notes that, in California, what began as the San Joaquin County Medical Society's answer to Kaiser-Permanente (i.e., the San Joaquin Foundation for Medical Care) has spread to a growing movement that is now nationally recognized as a viable, effective, competitive model of health care delivery. Each foundation is a federation of fee-service practitioners into an organizational entity that can contract to provide designated services on a prepaid basis within a geographical area. This gives the foundation for medical care (FMC) many of the attributes of the health maintenance organization, and indeed, they are recognized in the Health Maintenance Organization Act of 1973, PL 93-222, as individual practice associations (D?rken, 1974). Additional details about the foundations are provided, including the participation of practicing psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)