An economic and clinical rationale for changing utilization review practices for outpatient psychotherapy

Journal of Behavioral Health Services and Research

Volumn 24, Issue 3, 1997, Pages 340-349

  Hennessy, Kevin D ^a   Green Hennessy, Sharon ^b,c  

^a U S DEPARTMENT OF HEALTH AND HUMAN SERVICES   (United States)

^b KENNEDY KRIEGER INSTITUTE   (United States)

^c JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONSUMER; HEALTH CARE COST; HEALTH CARE UTILIZATION; MANAGED CARE; OUTPATIENT; PSYCHOTHERAPY; UTILIZATION REVIEW;

EID: 3042906081     PISSN: 10943412     EISSN: None     Source Type: Journal    
DOI: 10.1007/bf02832667     Document Type: Review

References (56)

1. Herzlinger R, Calkins D: How companies tackle health care costs: Part III. Harvard Business Review 1986; 64:70-80.
2. Berman K: Health insurance rates keep climbing. Business Insurance 1987; 21:34.
3. Health Care Benefits Survey, 1988. Princeton, NJ: Foster-Higgins, 1989.
4. Frank RG, Salkever DS, Sharfstein SS: A new look at rising mental health insurance costs. Health Affairs 1991; 10:116-123.
5. Broskowski A: Current mental health care environments: Why managed care is necessary. Professional Psychology: Research and Practice 1991; 22:6-14.
6. Lawman RL: Mental health claims experience: Analysis and benefit design. Professional Psychology: Research and Practice 1991; 22:36-44.
7. Lowman RL: Economic Incentives in the Delivery of Alternative Mental Health Services. Paper presented at the 95th annual convention of the American Psychological Association, New York, Aug. 11-15, 1995.
8. Goldstein JM, Horgan CM: Inpatient and outpatient psychiatric services: Substitutes or compliments. Hospital and Community Psychiatry 1988; 39:632-637.
9. Manning WG, Wells KB, Duan N, et al.: Cost sharing and the use of ambulatory mental health services. American Psychologist 1984; 39:1077-1084.
10. Mosher LR: Alternatives to psychiatric hospitalization: Why has research failed to be translated into practice? New England Journal of Medicine 1983; 309:1579-1580.
11. Docherty JP: Myths and mystifications of managed care. Journal of Mental Health Administration 1990; 17:138-144.
12. Fox RE: The rape of psychotherapy. Professional Psychology: Research and Practice 1995; 26:147-155.
13. Herron WG, Adlerstein LK: The dynamics of managed mental health care. Psychological Reports 1994; 75:723-741.
14. Jellinek MS, Nurcombe B: Two wrongs don't make a right: Managed care, mental health and the marketplace. Journal of the American Medical Association 1993; 270:1737-1739.
15. Karon BP: Provision of psychotherapy under managed health care: A growing crisis and national nightmare. Professional Psychology: Research and Practice 1995; 26:5-9.
16. Richardson LM, Austad CS: Realities of mental health practice in managed-care settings. Professional Psychology: Research and Practice 1991; 22:52-59.
17. Wooley SC: Managed care and mental health: Silencing of a profession. International Journal of Eating Disorders 1993; 114:387-401.
18. Mechanic D, Schlesinger M, McAlpine DD: Management of mental health and substance abuse services: State of the art and early results. Milbank Quarterly 1995; 73:19-55.
19. England MJ, Vaccaro VA: New systems to manage mental health care. Health Affairs 1991; 10:130-137.
20. Taube CA, Goldman HH, Burns BJ, et al.: High users of outpatient mental health services, I: Definition and characteristics. American Journal of Psychiatry 1988; 145:19-24.
21. Horgan CM: Specialty and general ambulatory mental health services. Archives of General Psychiatry 1985; 42:565-572.
22. Howard KI, Davidson CV, O'Mahoney MT, et al.: Patterns of psychotherapy utilization. American Journal of Psychiatry 1986; 146:775-778.
23. Knesper DJ, Pagnucco DJ, Wheeler J: Similarities and differences across mental health services providers and practice settings in the United States. American Psychologist 1985; 40:1352-1369.
24. Shadle M, Christianson JB: Organization of mental health care delivery in HMOs. Administration in Mental Health 1988; 15:201-225.
25. Phillips EL: Length of psychotherapy and outcome: Observations stimulated by Howard, Kopta, Krause, and Orlinsky. American Psychologist 1988; 43:669-670.
26. Phillips EL: A Guide for Therapists and Patients to Short-Term Psychotherapy. Springfield, IL: Charles C Thomas, 1985.
27. Garfield SL: Research on client variables in psychotherapy. In: Garfield SL, Bergin AE (Eds.): Handbook of Psychotherapy and Behavior Change: Third Edition. New York: Wiley, 1986, pp. 213-256.
28. Frank RG, McGuire TG: A review of studies of the impact of insurance on the demand and utilization of specialty mental health services. Health Services Research 1986; 21:241-266.
29. Horgan CM: The demand for ambulatory mental health services from specialty providers. Health Services Research 1986; 21:291-320.
30. Taube C, Kessler LG, Burns BJ: Estimating the probability and level of ambulatory mental health service use. Health Services Research 1986; 21:321-340.
31. Wells KB, Keeler EB, Manning WG: Patterns of outpatient mental health care over time: Some implications for estimates of demand and for benefit design. Health Services Research 1990; 24:773-789.
32. Simon GE, VonKorff M, Durham ML: Predictors of outpatient mental health utilization by primary care patients in a health maintenance organization. American Journal of Psychiatry 1994; 151:908-913.
33. Walker JD, Aquilina D, Needle PR: Managing mental health costs. Health Span 1986; 3:11-15.
34. Haas LJ, Cummings NA: Managed outpatient mental health plans: Clinical, ethical, and practical guidelines for participation. Professional Psychology: Research and Practice 1991; 22:45-51.
35. Options announces clinical model for "back end" management. Mental Health Weekly, January 22, 1996, p. 3.
36. Cummings NA: The successful application of medical off-set in program planning and in clinical delivery. Managed Care Quarterly 1993; 2:1-6.
37. Fuller MG: More is less: Increasing access as a strategy for managing health care costs. Psychiatric Services 1995; 46:1015-1017.
38. Mumford E, Schlesinger HJ, Glass GV, et al.: A new look at evidence about reduced cost of medical utilization following mental health treatment. American Journal of Psychiatry 1984; 141:1145-1158.
39. Holder HD, Blose JO: Changes in health care costs and utilization associated with mental health treatment. Hospital and Community Psychiatry 1987; 38:1070-1075.
40. Pflaumm BB: Seeking sane solutions: Managing mental health and chemical dependency costs. Employee Benefits Journal 1991; 6:31-40.
41. Howard KI, Lueger RJ, Maling MS, et al.: Aphase model of psychotherapy outcome: Causal mediation of change. Journal of Consulting and Clinical Psychology 1993; 61:678-685.
42. Employee Assistance Program Financial Offset Study: 1985-89. St. Louis, MO: McDonnell Douglas Corporation and Alexander Consulting Group, 1990.
43. Seligman MEP: The effectiveness of psychotherapy: The consumer reports study. American Psychologist 1995; 50:965-974.
44. Orlinsky DE, Howard KI: Process and outcome in psychotherapy. In: Garfield SL, Bergin AE (Eds.): Handbook of Psychotherapy and Behavior Change: Third Edition. New York: Wiley, 1986, pp. 311-381.
45. Howard KI, Kopta SM, Krause MS, et al.: The dose-effect relationship in psychotherapy. American Psychologist 1986; 41:159-164.
46. Mintz J, Mintz LI, Arruda MJ, et al.: Treatments of depression and the functional capacity to work. Archives of General Psychiatry 1992; 49:761-768.
47. Whiston SC, Sexton TL: An overview of psychotherapy outcome research: Implications for practice. Professional Psychology: Research and Practice 1993; 24:43-51.
48. Two-thirds of patients pay their own psychiatry fees. National Psychologist, May/June 1994, p. 4.
49. Cutting prices to attract self-pay clients. Psychotherapy Finances, November 1994, p. 3.
50. Frank RG, Goldman HH, McGuire TG: A model mental health benefit in private health insurance. Health Affairs 1992; 11:98-117.
51. Arons BS, Frank RG, Goldman HH, et al.: Mental health and substance abuse coverage under health reform. Health Affairs 1994; 13:192-205.
52. Keeler EB, Manning WG, Wells KB: The demand for episodes of mental health services. Journal of Health Economics 1988; 7:369-392.
53. Wells KB: Cost containment and mental health outcomes: Experiences from U.S. studies. British Journal of Psychiatry 1995; 166(Supp.):43-51.
54. Simon GE, Grothaus L, Durham ML, et al.: Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization. American Journal of Psychiatry 1996; 153:331-338.
55. Intergovernmental Health Policy Project: States return to parity, mandated benefits debate. State ADM Report 1994; 34:6-7.
56. Newman R, Bricklin PM: Parameters of managed mental health care: Legal, ethical, and professional guidelines. Professional Psychology: Research and Practice 1991; 22:26-35.