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A fork in the road: decision time for behavioral pediatrics
K J Kelleher1, S H Scholle, H M Feldman
1University of Pittsburgh School of Medicine, Pennsylvania, USA. kelleherkj@msx.upmc.edu
Insights
Managed care growth challenges developmental-behavioral pediatrics. Rethinking practice models and advocating for integration with primary care or mental health networks is crucial for children with special needs.
Area of Science:
- Pediatrics
- Healthcare Management
- Behavioral Health
Background:
- Managed care, particularly managed behavioral healthcare organizations (MBHOs), is rapidly expanding.
- This growth risks fragmenting care for children with medical and behavioral issues and diminishing the role of developmental-behavioral pediatrics.
Purpose of the Study:
- To analyze the impact of managed care on developmental-behavioral pediatrics.
- To identify barriers faced by developmental-behavioral pediatricians within managed care systems.
- To propose alternative practice models and recommendations for the field.
Main Methods:
- Review of the structure and operations of MBHOs.
- Identification of challenges and barriers to service provision.
- Description of potential alternative practice models.
Main Results:
- Managed care is likely to lead to the integration of developmental-behavioral pediatrics with primary care or specialty mental health networks.
- Barriers exist for developmental-behavioral pediatricians in navigating managed care structures.
Conclusions:
- Developmental-behavioral pediatrics must adapt to managed care trends by integrating into primary care or mental health networks.
- Proactive discussion, advocacy, and strategic planning are essential for developmental-behavioral pediatricians to maintain their role in caring for children with special needs.
Abstract:
The rapid growth of managed care, and especially that of managed behavioral healthcare organizations (MBHOs), is likely to diminish the role of developmental-behavioral pediatrics and separate care for medical and behavioral problems. Thus, a rethinking of the practice of developmental-behavioral pediatrics is required. This study reviews the structure of MBHOs, identifies barriers to the provision of services by developmental-behavioral pediatricians, describes alternative practice models for consideration, and makes recommendations. The aims of the recommendations are to stimulate an active discussion about these issues, spark an advocacy effort, and ensure the continued participation of developmental-behavioral pediatricians in the care of children with special needs. The study concludes that managed care will push developmental-behavioral pediatricians into integration with primary care group practices or into specialty mental health networks. Immediate discussion, action, and advocacy will be required to ensure a presence in these decisions for developmental-behavioral pediatricians.