Maneuvering the Maze of Managed Care: Skills for Mental Health Practitioners

Kevin Corcoran and Vikki Vandiver. New York: Free Press, 1996. 352 pp. $20.00.

Maneuvering the Maze of Managed Care is a well-written, comprehensive resource text that should be on the bookshelves of all mental health practitioners. The authors have consolidated the most current and definitive information about providing mental health services in a managed-care environment. They intermingle their discussions with suggested assessment worksheets, resources for clinical measures, and recommended strategies for affecting change with clients. Viewing managed mental health care "more as a friend than a foe," the authors rise above negative assertions about the "evils" of managed care to discuss how the system may benefit clients and practitioners. Managed-care companies generally govern service patterns by emphasizing cost and quality. Although cost containment and quality assurance are necessary goals, the methods used to attain them have produced responses among practitioners that range from mild apprehension to outright fear. Such emotional reactions are generally associated with indecision about how best to practice within the maze of managedcare systems. This book helps practitioners overcome some of their apprehension and fear. It arms them with the tools and skills they need to be effective providers in a cost-conscious environment.

In chapter one, the authors present an overview of the development of managed-care systems. They describe the present health care system as having evolved because of economic factors from a two-party system (client-mental health provider) to a four-party system (client, mental health provider, third-party payor, and managed-care company). The two most prominent managed-care models in current mental health practice are the self-contained model and the fee-for-service or case-by-case model, subsequently described and discussed throughout the rest of the book.

In chapter two, the authors summarize the arguments about managedcare services. The arguments focus on three themes: control and autonomy by practitioners, money, and the cost-effectiveness of managed care. A key criticism of managed-care companies is that they have the greater balance of power in the treatment process because they hold the purse strings affecting clients' treatment plans and practitioners' income. However, Corcoran and Vandiver suggest that the managed-care environment will undergo changes in the not too distant future. Their suggested standards for change (i.e., cost-effectiveness, responsiveness to practitioners, and the clients' best interest) support a collaborative rather than adversarial relationship among practitioners, managed-care administrators, and clients. But the authors fail to acknowledge that increased competition among the various disciplines within the mental health profession could conflict with collaborative efforts. Increasingly, practitioners in competing disciplines will feel compelled to demonstrate their uniqueness and effectiveness to managed-care administrators; their collaboration may not come easily.

Corcoran and Vandiver provide an overview in chapter three of the association between managed-care programs and capitated mental health services. Examples of various preferred, short-term services emphasize helping the client resolve presenting problems. The authors also discuss treatment evaluation, an essential component of service provision, that is often based on client-satisfaction surveys. Although recognizing the limitations of satisfaction surveys, the authors provide constructive suggestions about how best to use them for evaluating practice and assessing quality. Chapter three concludes by highlighting the risks and benefits of capitated managed-care systems. Cost incentives to limit treatment, limitations of informed choices, and restricted use of innovative treatment protocols are the primary risks associated with capitated systems. The benefits of capitated systems include the creation and use of community-based and case management services that put together an interdisciplinary network of referrals, support systems, and treatment services.

Chapters four and five examine the procedures for prospectively determining treatment necessity and preauthorizing services with managed-care companies. The authors present various assessment protocols that objectively support a client's need for treatment. Chapter six examines similar issues from the perspective of continuing treatment services and evaluating services (concurrent and retrospective reviews). These chapters are instructional for practitioners because they feature multiple approaches practitioners may use to provide unbiased information to managed-care companies. The authors had the opportunity, but did not pursue it, to encourage practitioners to become responsible for communicating to the practice community their successful (and nonsuccessful) experiences with various intervention techniques. Information-knowing when something works, how it works, and why it works-is one of the most important tools that all practitioners need.

Chapter seven, which addresses the issue of cultural diversity, is one of the most valuable chapters in the book. The authors encourage practitioners to provide culturally competent services to ethnically diverse groups in a managed-care environment. Attention is directed toward African Americans, American Indians, Asian Americans, and Hispanic Americans. Corcoran and Vandiver highlight the cultural values unique to each group, recommend health promotion strategies to improve access to services, and list several diagnostic tools to assess the mental health status of ethnic minority clients. They provide a useful index of measurement tools that all mental health practitioners who work with minority clients should consider incorporating in their assessment plans.

In chapter eight, the authors discuss ethical and legal conflicts that practitioners working in managed-care systems encounter. The authors proceed through an array of issues ranging from conflict of interest and confidentiality to the provider's ethical and legal duties. This is a "must read" chapter for all mental health practitioners.

In chapter nine, Corcoran and Vandiver discuss the importance of promoting client involvement in the treatment process. The authors recommend that clients participate in the managed-care process by setting goals, monitoring change, and facilitating the completion of utilizationreview surveys for treatment evaluation. They recommend several techniques to encourage client participation as an integral component of the treatment process.

In the final chapter of the book the authors discuss the future development of managed-care organizations. They believe that distinctions between private and public managed-care systems will decrease, restrictions on covered services may become greater, and the size of managedcare companies may increase. A list of periodicals that publish on managed mental health care topics is provided to help practitioners prepare for the unpredictable future.

In summary, Maneuvering the Maze of Managed Care is highly recommended for therapists, mental health planners, managed-care administrators, and policymakers. This book is also appropriate for students preparing for work in the mental health field. It clearly presents the major issues in the field and suggests ways to manage those issues. The authors have given practitioners a base from which to maneuver through the managed-care environment.

Deborah M Whitley Department of Social Work Georgia State University Atlanta, Georgia

Copyright Family Service America Jul/Aug 1997
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