Adapting to health care reform and managed care: Three strategies for survival and growth.

Abstract

This article focuses on the impact on and reaction to managed care (the most apparent manifestation of the health care reform process) by psychologists. The recent historical context of the managed care industry is reviewed to offer a more pragmatic understanding of both its present evolution and its potential for being positively influenced by psychologists. Also, specific attention is given to diversification within the practice of psychology, alternative organizational structures, and reintegrating psychology into the treatment evaluation process. The need for psychologists to expand their influence into leadership roles in the evolving health care system will be addressed. J. G. BENEDICT served as action editor for this article.

The effect of technical support on clinician attitudes toward an outcome assessment instrument

“…2,3 As a result, various cost control strategies have been implemented by the purchasers of health care (such as businesses, governments, and insurance companies), including managed care strategies. [4][5][6] Managed care began in the 1980s with the implementation of diagnosis-related group (DRG) reimbursement practices by the federal government under the auspices of the Medicare program. 4 Additional managed care strategies have been implemented, such as documenting the medical necessity of care, fee schedule agreements (such as discounted fees and capitated plans), 5'7 the use of gatekeepers, 8 and utilization review.…”

The Revolution and Evolution of Family Therapy and Family Psychology

“…Unlike the earlier, unrestricted golden years, when health costs soared as independent practitioners billed insurance companies on a fee-for-service delivery system, employers, who pay the bulk of healthcare costs for their employees, turned in the mid-1980s to managed care insurance programs to control escalating expenses. Health maintenance organizations (HMOs), a form of managed care, have since emerged as the dominant healthcare delivery system in the United States, forcing most practitioners into unfamiliar, time-limited, cost-conscious ways of offering their services (Hersch, 1995).…”

New areas for psychological assessment in general health care settings: What to do today to prepare for tomorrow

“…possible ethical issues; that is, whether the referring physician may "lose" the patient (i.e., a testing referral may lead to a therapy referral that could result in the patient's leaving the referring physician's practice to be seen by a specialist); and A Collaborative Model Assessment psychologists working in conjunction with primary care physicians, internists, family practitioners, or other medical specialists need to be sensitive to the referral question and their subsequent treatment recommendations. For example, issues of medication or rehabilitation compliance are key in such settings (Hersch & Staunton, 1995). Cattell (1977) noted that "since the days of Hippocrates, discerning physicians have recognized the close relationship between the personality makeup of their patients and the diseases those patients contract.…”

“…Generalist psychologists can aid physicians by using testing to provide early identification of the existence of any psychological factors that may contribute to an illness. Engaging the patient with a psychologist can then further aid in subsequent compliance with the physician's recommendations (Hersch & Staunton, 1995). In developing a good collaborative relationship with a physician, the psychologist might consider intervention aspects of care, not just evaluation, to 1. aid in the communication of test results to the patient or family; 2. construct behavior modification plans for enhancing treatment, medication compliance, or both; 3. aid with psychosomatic illnesses; 4. help patients and families cope with a debilitating disease or chronic disorder; 5. consult for medically mandated lifestyle changes (e.g., diet, smoking cessation); and 6. assist a patient and family who must cope with news of a fatal disease diagnosis.…”

“…Within this type of collaborative model, physicians who are using such consultation may wish to have the psychologist provide on-site services at their medical offices (Hersch & Staunton, 1995). Doing so is potentially beneficial in a number of ways.…”