Limited Therapy Effects of Managed

¶ … Limited Therapy

Effects of Managed Care in Counseling

Managed care is nothing more than a term that describes the business of insurance and its relationship to professional health services including counseling (Gervais, 1999). While some consider managed care as the solution to inadequate health insurance, many others realize that the restrictions placed by managed care agencies may actually severely impeded patients access to continuous counseling and treatment.

Today a majority of patients are covered by managed mental health care organizations (Kent, 2000). Some studies suggest as many as 170 million people are covered by m managed care mental health programs (Joseph, 1997). One of the problems associated with managed care is capitation agreements, which allow managed care organizations to monitor patient utilization of services. Case and care managers are appointed that review services, though in the case of mental health services primarily psychiatric nurses are responsible for this function (Kent, 2000). The most often cited complication of managed therapy is that managed care "intrudes in the therapy process" (Kent, 7). This violates among other things, client confidentiality and prevents psychologist autonomy with respect to the style of practice they wish to recommend (Kent, 2000).

Psychologists are also less able to follow treatment plans that are behaviorally-based or that allow well defined goals, in part because managed care organizations consistently step in to set limits on treatment (Drotos, 1997; Jeffrey, 1998; Kent, 2000). Psychological testing is also now limited because of directives from managed care organizations requiring many psychologists to conduct cost benefit analysis to determine whether a test will increase costs (Kent, 2000).

In addition far too often therapy is now authorized by managed care organizations rather than the practicing psychologist (Kent, 1995). Most of the therapy offered is also short-term thanks to directives from managed care organizations, when most psychologists would prefer establishing a long-term relationship to ensure the well being of the patients involved (Bistline, Sheridan & Winegar, 1992). By far the biggest issue is time limited therapy, which encourages treatment models that limit the amount of time a patient needs to spend in treatment (Bistline, Sheridan & Winegar, 1992; Kent, 2000).

New treatment models have been developed not on the grounds of how they may benefit patients, but rather as a means to shorten psychotherapy and accommodate an HMO insurance environment (Ackley, 1997). In addition managed care organizations are emphasizing group treatment and time limited therapies so that treatment can be offered large populations more quickly and less expensively (Kent, 2000). Group treatment models however are often not preferred by any psychologists (Kent, 2000).

There are other issues that managed care presents in the counseling profession. Larson, Zhang, Smith and Kasten (2005) propose that access to Medicaid insurance is more likely to influence counseling and patients ratings of care than managed care involvement in their treatment. Kim, et. al (2005) conducted a study suggesting that preventive education and counseling may improve outcomes for women. Unfortunately not all managed care organizations promote such practices.

Gervaise et. al, (1999) point out that increasingly financial reimbursement restrictions from managed care agencies play a critical role "in the quality of patient care" (1). According to the researchers, "complicated contractual arrangements among multiple providers obstruct rather than facilitate provisions for continuity of patient care" (Gervaise, et. al, 1).

New Advances In Modern Care - Addressing Time Limited Therapy

In the short- and long-term it is likely that limits on therapy will remain. Thus new treatment models must be developed to ensure adequate care. New requirements and restrictions placed by managed care organizations necessitate change in the health care field. Much of the research available supports more training for psychologists so they learn techniques for succeeding using group therapy practices (Drotos, 1997; Kent, 2000; Joseph, 1997). Group oriented approaches enable successful time limited treatments and cost effective services that health maintenance organizations are more likely to support.