A four-year study of enhancing outpatient psychotherapy in managed care

This study was a first step in explicitly attempting to open, at least partially, the "black box" of specialty managed mental health care by examining qualitative as well as quantitative aspects of managed outpatient mental health treatment. The Goal Focus Treatment Planning and Outcomes (GFTPO) program was studied as an example of a relatively simple, patient-specific, structured educational intervention with a modest capacity to affect practice patterns and care over time among network clinicians.

Four years of data from an enhanced care management program (N=28,741) designed to facilitate focused, goal-oriented, accountable outpatient psychotherapy and appropriate use of medications were used to illustrate what was actually done in one large national managed behavioral health organization. Random samples of persons from seven matched pairs of GFTPO (N=17,752) and non-GFTPO (N=10,989) employer groups from 1995 to 1998 were studied in a quasi-experimental design. The effects of GFTPO were tested by analyzing samples compared on five measures of outpatient psychotherapy: errors in prescribing medication, continuity of therapists, early termination of treatment, likelihood of multiple treatment episodes, and the use and cost of services.

The GFTPO sample showed a lower incidence of medication prescribing errors and therapist switching as well as shorter treatment episodes in the year after the start of outpatient treatment. No differences were observed in the likelihood of early termination or of having multiple treatment episodes. Cost savings did not appear to be at the expense of quality of care.

It is possible to enhance the potential for measuring and influencing the quality of care in large organized systems.