One of the nation’s largest mental health care carveout firms, Magellan Behavioral Health, has agreed to change the way it deals with one of the many contentious issues on the battleground between psychiatry and the managed care industry. It has agreed to remove, or at least lower considerably, the barriers that kept young psychiatrists from being credentialed for its provider panels.

Since managed care gained considerable control over the health insurance industry, psychiatry residents and early career psychiatrists have faced an often futile struggle to gain access to provider panels. That’s because they haven’t practiced medicine long enough to meet the criteria the industry established to control which physicians and health professionals can join its networks. One frequently used criterion, for example, is certification by the American Board of Psychiatry and Neurology (ABPN).

At meetings with Magellan last fall, APA President Allan Tasman, M.D., Medical Director Steven Mirin, M.D., and Sam Muszynski, director of the APA Office of Health Care Systems and Financing, informed company officials of the problems their credentialing policies are causing for residents, early career psychiatrists, and the field of psychiatry in general. Tasman revealed the results of those discussions at last month’s Board of Trustees meeting in Washington, D.C.

He passed out copies of a letter from Magellan Behavioral Health’s executive vice president and chief medical officer, Jonathan Book, M.D., in which Book stated that Magellan would change its credentialing policies to make it easier for young psychiatrists to get the reimbursement and experience that network participation affords.

Tasman stressed that this acknowledgment from Magellan did not result from any type of negotiation between APA and the company. APA "asserted" that the policies were harmful and needed to be changed, explained how the credentialing problem is affecting psychiatrist training and patient care, and called on the company to remedy the situation, Tasman said.

Book said in his letter to Tasman that Magellan agrees with APA that it and other managed care firms "should be supporting ways for psychiatric residents and early career psychiatrists to participate in evaluating and treating patients covered under managed care in order for them to be prepared to provide quality patient care in all settings."

He described three principles that Magellan will use as it alters its credentialing policies to accommodate residents and early career psychiatrists. First, residents will be eligible to provide reimbursable clinical services through organized systems of care that are part of the company’s network as long as the program meets three criteria: the residency program’s clinical services are credentialed by Magellan, the program is JCAHO accredited, and ABPN-eligible faculty members supervise the residents.

Second, psychiatry residents in PGY-3 through PGY-6 can be individually credentialed as participating providers if they are "in clinical service programs affiliated with or under contract with the residency training program." They will receive credentials to provide care in the affiliated residency training program.

Third, the company will not require ABPN certification for network eligibility. "Individuals who meet the training and examination requirements for the ABPN are eligible to be credentialed on a Magellan panel," Book pointed out.

Credentialing hurdles are only one of the troubling issues on APA’s agenda with Magellan and other managed care companies. Book’s letter noted that Magellan is also "reviewing issues regarding confidentiality of patient medical records and pharmacy benefit management" and the standards it uses to measure "quality patient care." He said as well that Magellan appreciates "substantive input by APA," views it as "important," and welcomes additional opportunities to discuss "matters of mutual concern."

Tasman told Psychiatric News that of the several issues APA put on the table at the October meeting, Magellan’s "unnecessarily restrictive credentialing policies were the easiest for the company to address."

The promised change in policy "will open up more opportunities for patients to be seen by psychiatrists," Tasman said. "It will also allow psychiatrists in training to see as broad a range of patients as possible and to see patients within systems of care and at a time when trainees can be supervised by people who know what state-of-the-art treatment is all about."

He noted that APA is waiting to hear when or whether Magellan will respond to APA’s concerns about other issues that were discussed, such as the kinds of practice guidelines the company uses when it reviews psychiatric treatment, policies that limit access to care, restrictions on participating psychiatrists’ scope of practice, and reports of discrimination against IMGs who try to join provider networks.

Magellan is not the only carveout with which APA has had a dialogue about harmful managed care practices, Mirin told the Board. APA has also met with Value Options, Cigna, and United Behavioral Health on these issues.