Just as managed behavioral health care evolved incrementally over the past 15 years, fueled by myths and lubricated by expediency, it is time for it to devolve, shedding its most dysfunctional elements. The managed care companies for the first time should be receptive to certain reforms, for very simple economic reasons: with declining profit margins, they need to reduce administrative costs. One way to do this is to abandon expensive and duplicative processes that no longer give them a competitive edge in the marketplace.

There are three modest changes that APA could advance. The changes would reduce the administrative-cost dollars that are consequently not available to support actual clinical services, improve patient access, and free psychiatrists from oppressive, and expensive, requirements.

• APA could join with the Medical Society Credentials Verification Organizations of America (e-mail: cwalder@epcms.org) to support the adoption by all behavioral health management companies of the Core Data Credentials Tool. The necessity of preparing duplicative credentialing and recredentialing materials for the many behavioral health care plans is a silly and counterproductive activity that in no way contributes to the quality of care afforded patients. APA could serve as a data warehouse, electronically transmitting the data as requested.

• APA could facilitate the development of a consensus about the data elements that are required for outpatient case management. Already, there is over 90 percent concurrence among the companies, but each has a different format. The Outpatient Treatment Plan already developed by APA could serve as a useful kickoff point.

• APA could make an excellent case for exempting all psychiatrists from outpatient case management. Of the ridiculously low percentage of the health care dollar that goes to behavioral health care, about 30 percent goes to overhead and profit; of the remainder, only about 30 percent, or 21 percent of the total behavioral health care dollar, goes to outpatient, office-based care. Psychiatrists, while having a significant presence in the composition of networks (to ensure hospital and crisis coverage), actually provide a small portion of outpatient treatment; probably no more than 20 percent of outpatient behavioral health care costs are generated by physicians—a mere 4 percent of total behavioral health care costs! Abusive practices can be controlled by outlier analysis and provider profiling, no longer punishing the innocent by requiring every physician to generate outpatient reports that are never read and in no way influence quality of care.

The role of convener is a powerful one in today’s anti–managed care environment. For example, the small American College of Mental Health Administration has facilitated a successful process with all of the accrediting bodies—such as JCAHO and NCQA—to develop a consensus about outcome measures, reducing the risk of conflicting or confusing demands upon provider groups and agencies.

Similarly, APA could convene senior representatives of managed behavioral health care companies to forge an agreement on uniform credentialing, treatment plans, and exemption of psychiatrists from outpatient case management.