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Table of Contents
AHP Preface - By Georgia Berland, Executive Director of the Association for Humanistic Psychology
Additional Preface - By Larry M. Leitner, Ph.D., Professor of Clinical Psychology, Miami University
History of the growth of U.S. managed care medical and mental health plans
Managed care health plans and the rising cost of health care
Health care systems in transition
Managed care mental health plans
Residential treatment cost savings
Employee Assistance Programs (EAP) philosophy enters full outpatient psychotherapy care
Miller's "first generation" plans
Miller's "second generation" plans
The coming of "carve-out" managed care mental health organizations
Miller's "third generation" plans
Two realities
Four losses
Inadvertent consequences of applying managed care to outpatient mental health care
Tables 1A and 1B: Data from therapist assessment of managed care – Tucker and Lubin national study
Loss 1
Consumers have lost the right to choose their own clinicians for outpatient mental health treatment
Loss 2
Outpatient mental health clinicians have lost access to many prospective consumers' health plans (no covered reimbursement anticipated for that consumer's treatment)
Loss 3
Loss of right by consumer and clinician to choose their way of doing therapy during their covered outpatient mental health treatment
Role of short-term treatment methods
Loss 4
Loss by both parties of right to determine duration of covered treatment
Three developments leading to the present
Framing the study’s research questions and hypotheses
Stated as research questions
Stated as hypotheses
Limitations and delimitations
Limitations
Delimitations
1. Design of a Point of Service Triple Option outpatient managed care mental health plan
2. Feasibility study of POSTO cost-neutrality
3. Focus group (also functioning as a stakeholder expert group and as an idealized systems design imaging group)
4. Focus group research use of Likert scales
5. Qualitative focus group transcript content study
Selection of participants for the focus group
Desirable characteristics
Table 1: Stakeholder categories: One or more a necessary background for focus group members
Choosing group participants
List of focus group members who agreed to the April 1999 Berkeley focus group meeting
Rationale for using a half-day focus group to study: (a) four losses, (b) the POSTO outpatient mental
health plan design, (c) the participants' own fundamental thinking emerging together
Emergence of stakeholder opinion
Distance
Rich body of data
Client satisfaction
Group size
Preparing for the focus group meeting
Table 2: The study's sources of evidence to confirm or disconfirm the hypotheses
Table 3: Subjects studied by each research method
Point Of Service Triple Option (POSTO) plan design and
the four losses
Improving on Loss 1
Improving on Loss 2
Improving on Loss 3
Improving on Loss 4
The two stages over time of the potential development of remediation for the four losses
Stage 1
Stage 2
The participant can choose option #1 at point of service:
Managed care HMO-style panel and peer case management
The participant can choose option #2 at point of service:
Managed care PPO panel with peer case management
The participant can choose option #3 at point of service
In the study’s focus group
I. Problem formulation
II. Design and justification
III. Assumptions about hypothetical models of health plans involved in the study
A POSTO outpatient mental health plan past example found in the field: Dr. Nick Cummings' model at American Biodyne
IV. Designing a point of service triple option (POSTO) managed care mental health plan to seek reasonable inner-plan premium cost neutrality among the three Options in the plan
V. Model for calculating managed care mental health POSTO costs and payments
Table 1: Hypothetical POSTO managed care outpatient psychotherapy plan: Consumer chooses among all licensed outpatient psychotherapy clinicians along the following model
Outpatient psychotherapy clinician cost, consumer cost, and cost to the health plan
Table 2: Most common per outpatient therapy visit rates in and near Sonoma County
Elements down and across the experimental grid
Table 3: Visit Fees
Reserving money in the outpatient psychotherapy budget for the potential scenario of moderately increased visits
Outpatient psychotherapy clinician cost, consumer (plan participant/patient/client) cost, and cost to the health plan
Table 4 $70/hour therapist fees
Table 5 $100/hour
Table 6 $110/hour
Notes to the calculations
Four losses
Tables 1A and 1B: Did losses occur? Chart 1: Focus Group Hour 1
Tables 2A and 2B: If losses occurred, were they important losses?
Consideration of the feasibility that a POSTO managed care outpatient therapy plan could ameliorate any of the four listed losses
Tables 3A and 3B: Does POSTO outpatient psychotherapy benefit design offer an advantage (or disadvantage) in addressing this problem?
Consideration of the expert collaboration in the focus group on possible recommendations for future outpatient psychotherapy plan design
Tables 4A and 4B: Six participant recommendations for the future of covered outpatient psychotherapy plan design
Qualitative focus group transcript study
First hour: FOUR LOSSES
Cost crisis transition to managed care clarified
Subject: Loss #1 – Consumer losing the right to choose therapist
Subject: Loss #2: Therapist loss of relationship with the consumers health plan
Subject: Loss #3: Both lose right to choose therapy mode
Subject: Loss #4: Both suffer loss of right to choose therapy duration
Hour 2: POINT OF SERVICE TRIPLE OPTION (POSTO)
Table 5: POSTO: Help with the losses?
Hour 3: SIX RECOMMENDATIONS
Table 6: Six Recommendations
Recommendation #1: Consumer learning
Recommendation #2 Education: preventive and lifestyle
Recommendation #3: Mind-body treatment
Recommendation #4: Increase medical cost knowledge, including with and without good mental health treatment
Recommendation #5: Increase quality assurance, including the role of providers
Recommendation #6: Provide for needs of special populations
Results
Answering the study’s research questions
Final thoughts
Appendix 1: Developing and costing a cost-neutral Point of service triple option managed care outpatient mental health plan by Chris Alesso
Appendix 2: Implications for further research: Medical cost offset
Appendix 3: Glossary
Appendix 4: Blank Likert scales for each of the three hours
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