A survey of what clinicians should know.

Abstract

There is general agreement among the major stakeholders—providers, consumers, payors, and managed behavioral health companies—that managed care poses significant challenges for behavioral health professionals, particularly those whose primary work has been in independent practice rather than organized care settings. In traditional independent practice, clinicians were free to employ relatively unstructured, goal-free approaches to care with an emphasis on patient insight and self-knowledge. Formal written treatment plans were a rarity and there was little external pressure on clinicians to complete treatment within any specified period of time. Often, little attention was paid to the efficient use of financial and service resources, and decisions to begin and end treatment were the purview of the therapist and the patient. Patients were generally seen as financially responsible for their treatment regardless of employment based benefits. Indeed, such an approach to practice was consistent with the ways in which most behavioral health professionals were trained. In contrast, clinicians practicing in today's managed care environment are typically required to develop written, goal-focused, time limited treatment plans emphasizing the return of the patient to an adequate level of day-to-day functioning while making efficient use of resources (Austad & Berman, 1991). Decisions to begin and end treatment, at least the part to be paid for through the benefit plan, are made by the therapist and patient together with a third party—the managed care entity. In order to work effectively within this context, clinicians must be both willing and able to change their practice patterns, to at least accommodate