Managed care is a health insurance system dominating in the United States in all the spheres of medical services, including psychological therapy. Managed care has both its opponents and proponents, particularly when issues related to behavioral health are discussed. It might be, therefore, useful to consider managed care in relation to psychological treatment, especially with regard to cognitive and behavioral therapies.
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There are three parties involved in managed care operations: a provider (a hospital, a therapist, a physician, etc.), a receiver of the services, and an insurance company serving as a mediator between them. The provider agrees to offer services at lower prices, while the insurance company, in turn, limits the client’s choice. Independent reviews conducted by insurance companies are supposed to reduce clients spending by eliminating unnecessary services. Although this system is widely accepted in the US, its critics claim that while it allows reducing costs of medical interference, it may deprive clients of the services they actually need. Managed care can significantly lower the prices for medical services and make them more accessible (Mullner & Chung, 2016). On the other hand, since in such a system it is an insurance company that decides whether a person needs particular services or not, it can discourage clients from resorting to expensive or prolonged treatment (Mullner & Chung, 2016).
It seems relevant to discuss managed care in relation to the main types of therapy dominating modern psychological care, such as cognitive, behavioral, and cognitive-behavioral treatment. The underlying assumption behind behavioral therapy is that, during their lifetime, people often acquire unhealthy coping mechanisms or resort to destructive behaviors (either for themselves or the people around) (Cherry, 2020a). Behavioral therapy aims to alter unhealthy behavioral patterns and to replace them with better ones. An influential psychologist Edward Thorndike was among the first specialists who suggested that behaviors can be changed: he argued that actions which are followed by a satisfactory result are more likely to reoccur in comparison to the ones which appeared fruitless; for example, if a child receives a toy after throwing a tantrum, they may think that it is a useful way to get what they want (Cherry, 2020b; Association for behavioral and cognitive therapies, n.d.). However, if parents do not give them a toy in this scenario, children are less likely to employ this strategy again.
Cognitive psychology is based on the idea that the way people think, the perceptions they have regarding the situation define their reactions. For example, if, during a panic attack, a person believes that they are dying, their condition is likely to get worse. In contrast, if they know that it is only a panic attack and reassure themselves that it is going to end soon, they are more likely to feel in control (Association for behavioral and cognitive therapies, n.d.). Cognitive therapy, therefore, aims to change the established thought patterns which are perceived harmful for the mental health of a patient. This theory was introduced by an American psychiatrist Aaron Beck in the 1960s (DeRubeis et al., 2019). He discovered some “common negative biases and distortions” among depressed patients (DeRubeis et al., 2019, p. 277). Cognitive-behavioral therapy implies combining the approaches of these two theories into one inclusive strategy, which aims to diminish both unhealthy thought and behavioral patterns. It also pursues the goal of providing patients with tools for dealing with those unhealthy behaviors and establishing better ones.
These relatively modern approaches to psychological therapy replaced the ones which implied prolonged analyzing of patients dreams or childhood memories. They are practice-based; therefore, patients often receive homework they have to complete between the sessions (Association for behavioral and cognitive therapies, n.d.). Cognitive-behavioral therapy aims to ensure that the negative thought and behavioral patterns of a patient have been detected and analyzed, and a patient has learned how to replace them with healthier strategies. This usually demands from 6 to 20 sessions (Association for behavioral and cognitive therapies, n.d.). Hence, it is particularly convenient for managed care systems that aim to reduce the prolonged receiving of services.
However, Lees (2016) claims that managed mental health care has not significantly improved the state of health care in the US and, on the contrary, reduced the quality of care provided and hinders accessing it (p. 39). He also claims that it disrupts the caretaker and patient relationship by putting a limit to the number of sessions for a specific mental illness (Lees, 2016, pp. 39-40). Insurance companies who are in control of treatment plans are usually more focused on economic efficiency. This may result in a reduction in the number of sessions or limiting inpatient days (Lees, 2016, pp. 38-40). Tarnoff (2018) also believes that managed care restricts the possibilities of mental health care. He claims that utilization reviews of emergency department recommendations for psychiatric hospitalizations tend to be “more challenging and time-consuming than for general medical hospitalizations” (Tarnoff, 2018, p. 8). However, psychiatric hospitalizations can be as urgent for a patient’s life as general ones; therefore, a delay may be dangerous.
However, there are also claims in support of applying managed care in behavioral health. For instance, a collective of researchers conducted a study into the Integrated Care Program provided by Medicaid in Illinois and found that such an approach can reduce costs without a negative impact on therapy for patients with behavioral health conditions (Xiang et al., 2019, p. 2). It can also be noted that managed care is constantly developing employing the concepts of integrated health care. According to World Health Organization (n.d.), integrated health services imply more extensive involvement of patients in making decisions regarding their health care, “empowering people to take charge of their health rather than being passive recipients of services” (para. 1). Making clients more involved in the process of creating treatment plans and establishing standards of providing medical care not only in times of emergencies, emphasizing the importance of disease prevention and rehabilitation can significantly improve managed care.
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Thus, it can be hard to firmly establish whether managed care has a positive or negative effect on behavioral health. On the one hand, it limits the possibilities of mental health specialists and their clients to create treatment plans by themselves. It can make a client think that they are rushed to get results as soon as possible (which will only exacerbate their stress), and their doctor feels as if they should produce some results immediately – but behavioral treatment is much more than that. As a result, there might be a significant number of people who leave therapy at a stage of only temporary improvements. Moreover, companies can avoid patients with conditions that require life-long treatment. However, cognitive and behavioral therapies imply problem-solving and action-based approaches, which emphasize efficiency over the duration. Therefore, it is they are the most convenient practices for managed care, and can significantly reduce a customer’s spending while still producing results.
The most crucial thing that should be highlighted in relation to applying managed care standards in mental health care is that every patient’s situation is unique – therefore, there should be no religious following of any rulebooks; instead, an individual approach must be exploited. It is essential to ensure that, according to integrated health care standards, patients and health professionals have opportunities to communicate and decide what is the best option for the client’s health – not which one is less costly.
Association for behavioral and cognitive therapies. (n.d.). About psychological treatment. Web.
Cherry, K. (2020). How behavioral therapy is used in psychology. Verywell Mind. Web.
Cherry, K. (2020). Edward Thorndike’s contribution to the field of psychology. Verywell Mind. Web.
DeRubeis, R. J., Keefe, J. R., & Beck, A. T. (2019). Cognitive therapy. In K. S. Dobson & D. J. A. Dozois (Eds.), Handbook of cognitive-behavioral therapies (p. 218–248). The Guilford Press.
Lees, J. (Ed.). (2016). The future of psychological therapy: from managed care to transformational practice. Routledge.
Mullner R.M., & Chung K. (2016). Managed care: Health insurance and system. Encyclopaedia Britannica. Web.
Tarnoff, G. (2018). Managed care and psychiatric treatment: Insurance companies, not patients or their doctors, are in charge. The Brown University Child and Adolescent Behavior Letter, 34(1), 8-8.
World Health Organization. (n.d.). What are integrated people-centred health services? Web.
Xiang, X., Owen, R., Langi, F. F. G., Yamaki, K., Mitchell, D., Heller, T., Karmarkar, A., French, D., & Jordan, N. (2019). Impacts of an integrated Medicaid managed care program for adults with behavioral health conditions: The experience of Illinois. Administration and Policy in Mental Health and Mental Health Services Research, 46(1), 44-53.