restricted number of providers to serve those who
enroll in the plan; costs for all services are fixed. A
preferred provider organization (PPO) has contracts
with outside providers (at a discounted rate) to
meet the needs of its membership; in exchange
for the discounted rate, the providers theoretically
receive an increased number of referrals. A point of
service (POS) plan combines features of HMOs and
PPOs in that members have more options regarding
how“managed”their health care choices are but
pay more for these non-managed features. For
example, members of POS plans pay more if they
choose to use providers that are outside the defined
provided network/list but less if the provider is
within network.
In response to increased demands from consu-
mers for more freedom in choosing providers, an
increasing number of companies and institutions are
offering high-deductible plans that allow more
choices but effectively shift the majority of the
costs to consumers (Bobbitt, 2006). These
consumer-driven health plans are seen as a way to
reduce overall costs to institutions—much the same
reason that prompted the development of HMOs
in the first place. Some, however, believe that this
first iteration of managed care, especially as applied
to mental health—called behavioral health care—
has failed (Cummings, 2006). As Cummings
notes, costs have continued to increase, clinicians
are receiving less money for their services, and clin-
icians spend an increasing proportion of their time
on paperwork and getting reimbursed than on
direct care.
What is the next stage of behavioral health care
likely to involve? Cummings (2006) predicts two
major models that are likely to be implemented:
consumer-directed health care plans and pay-for-
performance disease management models. As we noted
above, consumer-directed health care plans shift
the cost and responsibility of behavioral health care
services to the consumer. Individuals will be spend-
ing more out-of-pocket (even if they are ultimately
reimbursed from their tax-exempt health savings
accounts) and are likely to shop around to find the
highest quality services for the best prices. The sec-
ond model, the disease management model, provides
pay-for-performance incentives to clinicians to pro-
vide high-quality, effective services. In this way, clin-
icians will be able to share in the health care savings if
they are able to achieve the same results with less
intensive treatment (for example, fewer sessions).
What are all these changes in behavioral health
care management likely to mean for clinical psy-
chologists? As has been true for the last decade,
clients are likely to be seen for fewer sessions and
the psychological treatments administered are likely
to be from a list of evidence-based treatments. We
discuss evidence-based treatments (Kazdin, 2008) in
more detail in Chapter 11.
Second, some predict that self-care or self-help
methods will be used more (Clarke, Lynch,
Spofford, & DeBar, 2006). For example, clinicians
may utilize books, pamphlets, and handouts (i.e.,
bibliotherapy) as a first line of treatment or as an
adjunct to traditional face-to-face sessions. In addi-
tion, as we discuss below, computer- or Internet-
assisted therapy is more likely to be used in the
future. This is possible because many of the most
effective treatments for psychological problems are
structured and based on manualized therapies (e.g.,
cognitive therapy of depression). Self-help methods
are attractive as a first line of treatment because theyT A B L E 3-3 Common Features of a Managed
Behavioral Health Care
Organization
■ Identified as a business entity or corporate structure
■ Full range of clinical services is provided (or
arranged)
■ Credentialed provider network or staff delivery
system
■ Utilization and care management
■ Management information systems (track member-
ship, eligibility, and aggregate population data)
■ Systematic quality management and improvement
mechanisms
■ Ability to assume financial risk, including the pay-
ment of insurance claims
SOURCE: Adapted with permission from Bobbitt, B. L., Marques, C. C., &
Trout, D. L. (1988). Managed behavioral health care: Current status, recent
trends, and the role of psychology.Clinical Psychology: Science and Practice,
5 ,53–66. Copyright © 1988, Oxford University Press.
CURRENT ISSUES IN CLINICAL PSYCHOLOGY 73