Managed care and private practice: Clinical social work experience

Abstract

An estimated 176.8 million Americans were covered by managed behavioral health organizations (MBHCOs) in 1998. Current literature raises several concerns about access to and quality of mental health services delivered by these companies. This study was designed to empirically document practice changes experienced by clinical social workers in private practice. It was conducted with a nationwide sample 1150 social workers, randomly selected from the Diplomate Directory of the American Board of Examiners in Clinical Social Work. Subjects were sent a twelve page, 122-item survey which contained questions on demographic and private practice characteristics, general experiences with MBHCOs, the frequency of disagreements about treatment planning, and the frequency of appeal activity. A total of 530 responses were received, with 287 meeting the sample criteria of private practice and managed care experience.;Survey results indicated that all respondents who contracted with MBHCOs were dissatisfied to some degree with their experience. Those who had contracted with managed care tended to be younger, less experienced in private practice, had lower incomes, and had more training in short-term therapies and less in long-term therapies.;Respondents also reported that MBHCOs did not regularly and/or unilaterally determine treatment plans for clients. In fact, when there were differences of opinion between the practitioner and managed care, the treatment plan was determined by managed care slightly more than "occasionally".;This survey also found that a high percentage of respondents (53%) reported that they had appealed MBHCO treatment decisions, despite the implicit hazard of being removed from a panel or denied future referrals. Contrary to expectation, the percentage of respondents appealing decisions was independent of the percentage of income from managed care fees.;With the exception of two characteristics, there was no evidence of differences between respondents based on their practice fees generated from managed care clients. Practitioners, who derived half or more of their income from managed care, reported more training in short-term treatments and practiced more often in metropolitan areas than those who earned less than half of their income from managed care.