 |
 |
|
|
Two groups that together claim to represent millions of mental health care consumers and their providers under managed care issued a joint statement last month endorsing the right of plans to limit the number of providers and to use quality criteria that are not dependent on medical training and board certification.
The statement was issued jointly by the American Managed Behavioral Healthcare Association (AMBHA) and the Council for Behavioral Group Practices (CBGP). The AMBHA represents 12 managed behavorial health care organizations that provide care to more than 90 million Americans, while CBGP represents 50 behavioral group practices with a combined enrollment of more than 15 million Americans.
The part of the statement most germane to psychiatry states: "By limiting the number of providers and allowing criteria that assess organizational capacity and system integration, managed care organizations may select providers that differentiate themselves by demonstrating accountability for care management, treatment team coordination, information management, continuous quality improvement, and other features. . . ."
APA immediate past president Harold Eist, M.D., criticized the AMBHA-CBGP statement as symptomatic of the way in which managed care has undermined the doctor-patient relationship.
"They do not represent anyone other than the management of major corporations and managed care companies," said Eist. "They do not represent the best interests of the millions of people enrolled in those health plans.
"Decisions as to professional qualifications and competency that individuals would ordinarily make with regard to the care of their loved ones should not be in the hands of organizations who put profit before quality, and their bottom line before the best health care interests of individuals. There is something peculiarly paternalistic about the managed care organizations that feel they are in a better position to make health care decisions for the American people than are the American people themselves in consultation with their doctors. Would we tolerate this kind of intrusion into the purchase of automobiles, the purchase of groceries, or the employment of lawyers? Of course the answer is no. But when it comes to health care, which is more important than almost anything else, we have managed care companies setting themselves up as the authorities as to who can do what, and they have not been delegated this responsibility by society, nor do they have the competency, nor the interest in the public welfare, to make these decisions."
Both the AMBHA and CBGP share an interest in "documented accountability for clinical outcomes and promotion of integrated and coordinated delivery networks," said AMBHA Executive Director Clarke Ross, D.P.A. Both groups wish to promote the idea that providers can differentiate themselves by the quality of the services they provide rather than rigid academic criteria.
"There's more than an M.D. and board certification to differentiate the quality of professionals" in mental health care, said Ross.
Commented CBGP President Allen Daniels, Ed.D., "What we're trying to do is endorse the concept that behavioral health care is best provided in organized group practice delivery systems that can accommodate the full range of needs of the patient."
The AMBHA does not necessarily agree that "group practices are the best practices," said Ross, but they "clearly bring advantages to purchasers and consumers."
The joint statement is a result of a desire to "build a collaborative relationship which supports both of our constituencies," said Daniels.
All of CBGP's member groups include psychiatrists as part of the "delivery system," said Daniels. "The significance for psychiatry is that the joint statement endorses the role of multidisciplinary group practice delivery systems that include psychiatrists among the caregivers," he added. CBGP, however, is trying to stress the significance of a role for various levels of behavioral health care providers in integrated group practice, he said.
Daniels is the executive director of University Psychiatric Services, a multidisciplinary group practice affiliated with the department of psychiatry at the University of Cincinnati. He is a professor of clinical psychiatry in the University of Cincinnati College of Medicine's department of psychiatry.
Ross, who has a doctorate in public administration, was the deputy executive director of the National Association of State Mental Health Program Directors prior to joining the AMBHA.