Managed Care Essay

As recently as 1960, before the oncoming of managed rational wellness criminal maintenance, the mathematical functions of psychiatrists, psychologists, and clinical accessible workers tended to be distinct. Psychiatrists had the overall righteousness of patient c atomic number 18, conducted psych otherapy, prescribed medication, and supervised hospital concern. clinical psychologists conducted testing and permitd host therapy and other therapeutic modalities in institutions and hospitals. clinical genial workers put to deathed comprehensive psycho well-disposed assessments, counseled regarding family issues, and created relieve plans for patients in neighborly operate agencies.At that clock time, the affable wellness depicted object was far from overcrowded. With psychiatrists sacking in vehemence, clinical companionable workers and clinical psychologists sham more responsibility in noetic wellness discussion, and psychotherapy, in particular. The prolifer ation of managed vexation companies during the 1980s furthitherd the growingd involvement of clinical companionable workers and clinical psychologists. Beca drill of modify training and the less-expensive nature of their go, clinical hearty workers and clinical psychologists were more abstruse in providing psychotherapy to patients slimy from psychogenic distemper. (Committee on Therapy, host for the improvement of Psychiatry, 1992). Conflict in RolesAccording to Gibelman & Schervish managed health safekeeping companies obligate move this trend of expanding the roles and responsibilities of nonmedical providersprimarily clinical well-disposed workers and clinical psychologistswhile contract the scope of psychiatric entrust. Managed health assistance companies see clinical social workers in particular as an economical, substitutable source of labor for both clinical psychologists and psychiatrists in the interference of patients suffering from noetic illness. Pr esently, clinical social workers provide a wide array of serve to clients with genial illness in a assortment of scenes and at all wreakal levels of practice. clinical social workers practice in institutions, hospitals, school trunks, clinics, correctional facilities, and esoteric practices. They function in positions of direct service, supervision, guidance, policy development, research, community organization, and teaching method and training. Clinical social workers frequently perform assessments and arrange and develop run. In these roles they serve as gatekeepers and handling providers.For some time, clinical socialworkers hire performed the largest portion of releasing work done in the United States. Clinical social workers provide as much as 65 percent of all psychotherapy and psychogenic health services (1997). Payers feed begun to ask, What type of therapist is the approximately cost- legal? and What is the advantage of paying one profession higher fees than other for rendering the same service? when an objective review of empirical studies shows that there is no absolute proof that one profession move perform psychotherapy better than another. Such research leads managed c be companies to conclude that numerous of the cheaper sources of labor in the moral health field, such as clinical social workers, are as effective in administering discourse to patients suffering from mental illness as other more-expensive practitioners (Gibelman & Schervish, 1997) Individual verse Group PracticeWith managed dreads influence, outpatient interposition, and unavowed practice, in particular, has down a viable and increasingly important role for clinical social workers. Although mental health clinics and other institutions provide the greatest opportunity for clinical social workers, a growing number are at one time carrying out services in a primary setting of solo or chemical sort out private practice (Gibelman & Schervish, 1996). In 1995 , 19.7 percent of NASW members cited private solo and mathematical root word as their primary practice, and 45.5 percent as their secondary practice setting (Gibelman & Schervish, 1997). Findings indicate that the proportion of clinical social workers entering and practicing as private practitioners continues to grow (Gibelman & Schervish, 1996).The prospective treatment of patients in solo private practice may be in jeopardy, as managed trouble companies force clinical social workers and other mental health electric charge providers to join group practices. In group practices, clinical social workers, in combination with other mental health practitioners, provide individual and group therapy, family interventions, and a variety of other services, all through one office (Shera, 1996). These groups provide one-stop shopping, as well as greater access to less-expensive professionals, such as headwaiters-level clinical social workers. Managed finagle companies find that group pr actices are more efficient and cost-effective in the management of a population of patients (Johnson, 1995). As managed care companies continue to reduce reimbursement dollars, varys in multidisciplinary team structures are inevitable, with steady morereliance on masters-level service providers.Practitioner distinctions already involve begun to diminish in favor of more team-oriented patterns, with the boundaries between the uniqueness of the individual disciplines beginning to blur (Eubanks, Goldberg, & Fox, 1996). Psychiatrists often head the team, coordinating services in conjunction with psychotherapists and other mental health care providers on the treatment team. However, it is not unusual for a clinical psychologist or fifty-fifty a clinical social worker to lead the team, with the psychiatrist relegated to the role of psychopharmacology consultant kind of than an active team member (Brooks & Riley, 1996). TreatmentIn addition to changing the role of mental health pract itioners and the structure of treatment teams, managed care has forced the clinical social work profession and the mental health field in general, to examine how its members provide care. Managed care companies are exploring new ways they can provide the most effective services to more good deal under increasing resource constraints (Shera, 1996). The transition from fee-for-service to managed mental health care services has created an enti depone new culture for mental health care providers and consumers (Geller, 1996). Practitioners must accommodate their treatment to the preferences of managed care. Otherwise, they risk a decrease in referrals, which could ultimately lead to loss of status and income. Managed health care companies have exerted influence on the ways that mental health practitioners conceptualize their practice, forcing treaters to modify therapeutic interventions and practice protocols significantly (Shera, 1996).Brief therapy now appears to be the preferred mode of intervention (Gibelman & Schervish, 1996). Long-term psychotherapy has been near eliminated for all however private-pay patients. Managed care companies find that studies of short- and colossal-term therapy advert that design approaches are as good as or better than long-term treatment, except in special cases (Lazarus, 1996). The majority of interventions distinguishing themselves in comparative subject studies are based on behavioral or cognitive-behavioral theories. These treatments tend to be goal- and present-oriented, behaviorally specific, symptom-directive, advice giving, educational, collaborative, and aimed toward the resolution or amelioration of symptoms in relatively brief periods (Johnson, 1995). The cant in preference to brief modes of therapy by managed care organizations has changed expectations for therapists. Theoretical penchant of practitioners has become of great interest as managed care companies assure for practitioners who use brief treatment me thods (Giles, 1993).The practitioners most significantly affected by managed cares shift in preferred mode of treatment have been those who provide the extensive and intensive treatments of psychoanalysis and psychodynamic psychotherapy, predominantly clinical psychologists. Their emphasis on Freudian psychotherapies, which generally have a very long duration of outpatient care and discouraging results in the outcome literature, have been, criticized hard (Giles, 1993). Emerging models of psychotherapy endorsed by managed care organizations assume that the psychotherapeutic process occurs in pieces over time. In these models, psychotherapy functions as an active work relationship between the patient and the therapist, whereby the goal is defined as change rather than cure. Managed care companies focus on resolving patients dandy symptoms, rather than ridding them of their mental health conditions, has led to the gradual disappearance of the use of the psychodynamic model as the d ominant framework in the treatment of individuals suffering from mental illness (Edwards, 1997).Recently, group treatments have received attention as a cost-effective means of treatment (Iglehart, 1994). A group format allows a number of patients struggling with similar life issues to come together and attain by interacting with one another and a therapist, the group leader (Shapiro, 1995). Managed care companies support group designs, relying on numerous studies that demonstrate the efficacy of short-run therapeutic groups using behavioral and cognitive-behavioral approaches. Managed care organizations find group treatment inexpensive relative to other treatment methods, because one practitioner can treat many clients at once, significantly reducing billable hours of treatment incurred. The say-so of group treatment to alleviate the psychological problems of large numbers of people at relatively low cost makes group therapy an attractive pick for managed care companies (). Desp ite the utility gains, however, managed care companies do not rely on group treatments as widely as might be expected, primarily because of patients resistance to group treatment.Some patients find the idea of group treatment difficult to accept because they have a hard timeunderstanding how they volition benefit. umpteen patients prefer individual treatment sessions, where they have the therapists undivided attention. These patients may be embarrassed active their problems and reject the notion of others besides their therapist providing input. The logistics of setting up short-term groups, along with electric current therapist practice patterns, present additional impediments to managed cares use of group therapy (Crespi, 1997). Nevertheless, the immediate cost-effectiveness of groups, coupled with documented authoritative outcomes, has made the modality particularly appealing in mental health delivery systems and provides a compelling argument for their use (Crespi,1997). Pr ojectionManaged health care organizations have influenced the delivery of services in the mental health field considerably and depart undoubtedly continue to do so (Eubanks et al., 1996). Whether the developments instituted by managed care companies are greeted with pleasure, indifference, or hostility, general agreement exists that the treatment of patients suffering from mental illness will be irrevocably changed as managed care continues to alter drastically the delivery, definition, and outcome of treatment that patients receive. In the future, indicators (Iglehart, 1994) suggest that nonpsychiatric practitioners will emerge as the dominant providers of treatment. According to Giles (1993), managed care companies will expect nonmedical practitioners, such as clinical social workers to provide the bulge of outpatient care in the mental health care field. Clinical social workers are cost-effective, fully qualified providers of mental health care services in the eyes of managed c are companies.Distinctions between masters-level and doctoral-level providers will become more evident as masters-level practitioners assume primary responsibility for direct mental health services, and doctoral-level providers assume more administrative, supervisory, and research-oriented roles (Crespi, 1997). The rapid increase in managed cares influence, accompanied by the reduction of referrals to more-expensive specialists, suggests that requirement for clinical psychologists will continue to diminish (Johnson, 1997). As managed health care organizations restrict consumer choice of providers, many mental health professionals, such as clinical psychologists, may have difficulty joining reimbursement plans (Gibelman & Schervish, 1997).Despite the shift awayfrom doctoral-level providers and the narrowing role of the medical practitioner in the treatment regime of managed care companies, psychiatrists will apt(predicate) have an essential and keep role in the mental health care s ystem. According to Giles (1993), managed mental health care still needs medical practitioners for their knowledge of psychopharmacology and experience in prescribing medications. Scientific literature has demonstrated that psychotropic medications are an effective and essential treatment component for most psychiatric illnesses, and psychiatrists, being physicians, are currently the only ones who can prescribe these drugs with the knowledge to do so effectively. Another likely development with the influence of managed health care is the queerness of the solo practitioner (Crespi, 1997). Individual practitioners and small group practices will likely remain, but will probably represent a much littler proportion of psychotherapists (Committee on Therapy, 1992).With commentators predicting a demise in solo private practice, practitioners will either have to affiliate with managed mental health care groups or forego clients with insurance in favor of those able to feed private payment (Gibelman & Schervish, 1996). The psychotherapist who decides to operate outside of the managed care system faces not only a degree of professional isolation, but alike limitations in referrals and remuneration (Committee on Therapy). The managed care initiatives sweeping the nation have profoundly affected the ways that clinical social workers and other mental health practitioners deliver services to people suffering from mental illness (Shera, 1996). As these changes continue, clinicians working in a managed care environment will more often practice time-limited psychotherapeutic interventions and, in all but the rarest cases, the practice of unregimented intensive psychotherapy and psychoanalysis will take slip outside of the confines of the managed care arena.For the majority of mental health care consumers, therapeutic work will focus on precipitating stressors and acute exacerbation that may be treated within the reimbursable framework (Committee on Therapy, 1992 Crespi, 1 997). Finally, with managed cares increasing influence, use of outcome measurement and management will continue. Quantifiable data will play a bigger role in treatment decisions. Funding sources of mental health care services will increasingly seek quantitative methods to measure the forestand efficiency of different interventions to guide their purchasing decisions (Johnson, 1997). As managed care companies look for hard data to determine the most effective professionals and treatments, mental health care providers will have to quantitatively demonstrate effectiveness of interventions and treatment through evidence of patient improvement (Gibelman & Schervish, 1996). Thus, the capability to implement and infix in outcomes measurement processes is vital for any practitioner who wishes to operate in the managed care environment. ConclusionDespite widespread criticism and various efforts at reform, managed care companies continue to expand. Clinical social workers currently involve d in the mental health field, as well as incoming social work students interested in mental health, must take caution of the rapid developments in the field. Although the changes resulting from the influence of managed care present many challenges, they also create many opportunities for mental health care providers, and for clinical social workers in particular. To take advantage of these opportunities, clinical social workers, and the institutions educating them, must be prepared (Geller, 1996). Many clinicians currently practicing, as well as current and incoming graduate students, lack information on the breadth of these developments (Crespi, 1997).Clinical social workers must actively seek out continuing education courses, conferences, and journal articles discussing developments in the field related to managed mental health care to be better informed. In addition, schools of social work must update their curricula for incoming students to reflect the realities of changes in m anaged care. Graduate schools must educate future social workers regarding developments, providing students with the information and skills needed to survive in this evolving culture (Shera, 1996). Many social work programs are discovering that traditional curricula are no yearner adequate to prepare students for practice in the era of managed care. Managed cares emphasis on the provision of mental health services at contained costs requires specialized practice skills, particularly rapid assessment, brief treatment, and the ability to document treatment outcomes. Social work educators must incorporate these elements into their programs.As managed care continues to expand and evolve, social work educators need to continue to estimate itseffect on the training of current and potential clinical social workers. Educators in the field, along with graduate school instructors and administrators, must make the necessary changes to provide clinical social workers with the ability to adapt to the changing environment. quislingism with managed care is necessary for professional survival (Eubanks et al., 1996). Clinical social workers have an enormous role in the treatment of people suffering from mental illness and have a real opportunity to play a major role in managed mental health care (Shera, 1996). Clinical social workers must rise to the challenge.