Managing Managed Careby Michael Roberts, Linda K. Hurley
The introduction of the concept of managed care into mental and physical health care appears to be a juggernaut of unparalleled impact. The two extremes of thought about this impact are (I) that managed care is a villainous foe to be resisted in order to bring back the earlier halcyon years of independence in practice decisions with greater reimbursement for psychologists' services or (2) that managed care is a laudatory attempt to restrain health care costs that are out of control and spiraling upward by rooting out mismanagement and reversing financial incentives to provide unnecessary care. The former view calls managed health care such names as "mangled care" and distributes bumper stickers stating "Just Say No to HMOs. " The latter view points to the slowdown of increases in health care expenditures and the enhancement of health care affordability and appropriateness for greater numbers of persons resulting from managed care cost-containment strategies and service review procedures. Mental or behavioral health care has been as strongly impacted as medical care under managed care. Where managed care has forced practitioners' attention to validated procedures and to examining previous wasteful practices, we ap plaud the movement. Where managed care has had adverse impact, we think there needs to be greater public, legal, and regulatory attention to its excesses and abuses.
Description: This book provides an overview of managed care with guidelines for the child and family practitioner in private practice who wishes to maintain an independent practice in a managed care environment. It describes the basic functions and economic framework for managed care, and offers a general discussion of marketing opportunities outside managed care reimbursement structures as a means of protecting the integrity of a private practice from the "pitfalls" of managed care.
Purpose: Its purpose is to support the continued economic viability of clinicians in private practice. It describes the opportunities and obstacles in a managed care environment, and attempts to develop a framework within which a practice can be successful. It describes ways to educate managed care organizations about the importance of providing quality child and family services, and ways to develop an alternative patient base outside managed care. The book is a collection of anecdotes, research facts, and private practice war stories with an anti-managed care perspective, seemingly designed to motivate the private practitioner to keep on negotiating the difficult terrain of private practice in a managed care world.
Audience: It is clearly written for the child and family practitioner whose private practice is beleaguered by managed care utilization restrictions and downward financial pressures. It provides plenty of information to support the position of those who have an aversion to managed care, some of which may be marginally useful in negotiation for authorization of services and educating managed care organizations about the value and integrity of child and family services. The authors reflect a private practitioner and academic perspective, and are likely to appeal to those audiences.
Features: The book is a fairly traditional organization and presentation of descriptive information, scientific background, and clinical anecdotes. It is very readable and provides some concrete examples for implementing strategies, but its presentation is not very compelling
Assessment: This is not a very useful book. It provides little new information and reinforces a common notion that private practice is about quality and managed care is about money. This is not a very useful position for the private practitioner in today's market. There is little concrete advice here that has not been offered before. It presents a very one-sided and frequently inaccurate description of the worst aspects of managed care. There is nothing about more innovative aspects of managed care, including the development of a system of care for children and families which presents genuine opportunities for clinicians. This book will likely appeal only to those who already have an anti-managed care bias and seek more ideological support for that position. Even for that audience, however, there is really nothing new here.
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