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Clinically based managed mental health care

D P Olsen1

  • 1Psychiatric-Mental Health Nursing Program, Yale University School of Nursing, New Haven, CT, USA.

Nursingconnections
|July 1, 1997
PubMed
Summary
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Managed care models vary in clinical involvement. Clinically integrated managed care solutions are predicted to outperform less involved models by resolving key issues in provider-reimburser relationships.

Area of Science:

  • Healthcare Management
  • Health Services Research

Background:

  • Managed care represents a significant shift in the relationship between healthcare providers and those who reimburse them.
  • Existing literature identifies various problems within managed care, often linked to this evolving dynamic.

Purpose of the Study:

  • To examine problems in managed care within the context of changing provider-reimburser relations.
  • To review managed care models across a spectrum of clinical involvement.

Main Methods:

  • Analysis of managed care models situated at different points on a continuum of clinical involvement.
  • Review of literature identifying problems associated with managed care.

Main Results:

  • Models with varying degrees of clinical involvement were assessed against identified managed care problems.

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  • Two models featuring full clinical involvement were specifically examined.

    • Conclusions:

    • Clinically integrated managed care models are anticipated to become dominant.
    • Full clinical involvement in managed care is proposed as a solution to prevalent issues, leading to the replacement of less integrated models.