Introduction:
While discussing general health care, behavioral healthcare has been combined with managed care and integrated systems. This paper focuses on the role of managed care and integrated health systems in behavioral healthcare service delivery. Furthermore, the paper mentions significant figures in behavior therapy and cognitive therapy together with managed care implications. Moreover, the paper also discusses what managed care is and where it has been applied particularly in behavioral health services.
Key Theorists and Brief Descriptions:
Key Theorist in Behavioral Therapy: B.F. Skinner
B.F Skinner is widely considered a father of behavior therapy, this work laid the fundamentals for understanding human behavior and developing effective therapeutic approaches to numerous psychological disorders. Skinner proposes behavioral therapy that centers on the modification of improper behaviors through positive reinforcement (Nakao et al., 2021). However, at the heart of this is Skinner’s theory on operant conditioning which presents that behavior is influenced by outcomes.
Skinner is among the other means of behavior modification including positive reinforcement, negative reinforcement, and punishment. Specific behavior refers to positive reinforcement and the removal of stimuli is negative reinforcement (Nakao et al., 2021). On the contrary, punishment can be defined as administering penalties to deter unwanted behaviors.
The above interventions are widely used for behavioral therapy and demonstrate how external factors influence a change in behaviors. Due to that, the evidence-based approaches focused on manifest behaviors are derived from behavioral therapy and hence a necessity for managed care as well as integrated health systems.
Key Theorist in Cognitive Therapy: Aaron T. Beck
Aaron Beck is a major figure in cognitive therapy and he greatly influenced what psychotherapy should be about. The attention is here shifted to the identification and replacement of those negative thoughts which in turn causes emotional distress along with dysfunctional behavior. Beck’s therapy is based on the principle of the cognitive model, which states that thoughts and interpretations define emotions and behavior (Nakao et al., 2017). Under this theory, one’s self-concept about his reality is an affective state. In cognitive therapy, the therapist and client work together to find distorted or irrational thoughts. These include dichotomous thinking, overgeneralization, and catastrophizing. As a result of the elimination of these false beliefs, people will have more balanced thought processes.
Furthermore, cognitive therapy allows for the development of more beneficial patterns of thinking. People can develop good emotional health and engage in positive behaviors when they substitute irrational concepts that are destructive with rational ones (Nakao et al., 2021). The objective of cognitive therapy being incorporated into managed care is systematic and result-oriented. Cognitive therapy lays out specific techniques and processing methods that can be easily done and measured by the clients. This activity is consistent with managed care ideals of treatment outcome measurement and its reliance on evidence-based practice.
Behavioral and Cognitive Approaches in Managed Care:
The managed care principles are quite consistent with the behavioral and cognitive therapies because they emphasize evidence-based treatment as well as outcomes. It involves cost-effective and effective healthcare treatments in which behavioral or cognitive therapy provides structured time – time-limited interventions that are easily measurable, monitorable as well evaluatable.
Behavioral Approaches in Managed Care:
One of the methods for behavior management that can easily be applied in managed care settings is operant conditioning by Skinner. These are distinct methodologies having performance measures. Consequently, managed care incorporates evidence-based health practices as well as quantifiable objectives. For instance, managed care may decide to reward with medication or therapy session attendance. These programs encourage people to do certain things for better treatment compliance, leading and improved overall wellness. On the other hand, combining behavioral approaches and managed care enables physicians to address behavior-related issues while assessing their performance in reaching treatment target goals thereby improving quality as well as outcome effectiveness ratings for services offered.
Cognitive Approaches in Managed Care:
In particular, cognitive therapies such as Beck’s Cognitive Therapy are especially relevant within controlled environments. These therapies try to locate and dispute maladaptive thoughts, and beliefs that cause psychological distress or functional impairment. This process which uses cognitive interventions can help individuals to control or manage their thoughts and emotions because they have such tools available that result in less of the distress effects on mental health. In the context of managed care, standardized assessment tools can be utilized for assessing changes in cognitive functioning as well as continuous progress monitoring during therapy sessions allowing for minimizing integration issues associated with cognitively based therapies (Nakao et al., 2021). This enables a systematic assessment of treatment effectiveness and necessary adjustments. Other than the above, teletherapy or web-based platforms may be employed in cognitive therapy delivery to enhance service accessibility and reduce costs (Nakao et al., 2019). With cognitive approaches, it is possible to move the distortions from a man’s mind into healthier thinking to have better outcomes alongside behavioral healthcare services.
Definition and Purpose of Managed Care:
Managed care refers to an approach toward the provision of healthcare that strives for both delivery quality and cost containment. It involves various techniques and ways to coordinate and integrate healthcare service delivery in a desirable way (Heaton & Tadi, 2023). The core objectives of managed care are to provide health service that provides not only quality but also controllability in cost and optimality results. This is achieved through measures like utilization management in which services used are appropriate, network contracts that outline agreements with healthcare providers, and negotiated rates of reimbursement. The major goal of managed healthcare is to provide optimal value and efficiency in the provision of healthcare services that include timely appropriate treatments at a reasonable cost.
Pros of Utilizing Managed Care in Behavioral Health Services:
The key strength of using managed behavioral health services is access to care. Behavioral health services are also integrated primary healthcare in managed care systems leading to the provision of appropriate and timely treatment. Such an integration allows the early identification of behavioral health disorders thereby avoiding ED visits and improving overall outcomes.
Managed care in behavioral health services is also cost-saving. Managed care systems control the resources used by introducing measures including utilization management processes that ensure cost efficiency and minimize undue costs associated with healthcare. The network contracts and negotiated reimbursement rates are other strategies that help in cost containment by making behavioral health services available to consumers.
Managed care systems can also enable population access to affordable behavioral health services in turn yielding a positive impact on the overall outcomes for improved mental health of a whole community.
Cons of Utilizing Managed Care in Behavioral Health Services:
Although managed care has some advantages, there are several negative features regarding the utilization of behavioral health practices. A significant problem is the limited availability of providers. Most managed care networks are guided by their provider-specific network and individuals do not have wide choices when opting for behavioral health providers (Stanek, 2020). On the other hand, limited options may influence the therapeutic relationship between client and provider; both in terms of failing to address certain personal preferences or lack of compatibility with specific providers.
The other issue would be managed care treatment limitations. This may include the maximum lengths and types of treatments that are covered. For example, managed care may limit the number of sessions a client receives or endorse particular treatment modalities before initiation. These restrictions can affect the quality and overall efficiency of care to some extent since frequency, as well as duration, are critical in achieving desired outcomes ( Stanek, 2020). Besides, limitations of some evidence-based interventions cause problems among the providers in ensuring sufficient intervention is provided. Managed care organizations should be alert to these limitations and maintain close relationships with providers so that individuals receive qualified behavioral health services.
Conclusion:
Behavioral health services are mostly provided under the umbrella of managed care and integrated health systems. Evidence-based interventions that are easily measurable, like behavioral and cognitive approaches would best suit this model. Even though managed care in behavioral health services appears to have both benefits and drawbacks, it is an essential element of the modern healthcare system setting aside accessibility to treatment for its cost-effectiveness as well as improved results. Such factors are important for behavioral health practitioners to take into account and they must work with managed care organizations to assess the quality of services provided.
References
Heaton, J., & Tadi, P. (2023, March 9). Managed Care Organization. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557797/
Kelly, L., Conway, M., & Soper, M. (2019). Exploring the Impact of Integrated Medicaid Managed Care on Practice-Level Integration of Physical and Behavioral Health. https://www.chcs.org/media/BH-Provider-Brief_070219.pdf
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1). https://doi.org/10.1186/s13030-021-00219-w
Stanek, M. (2020). Promoting Physical and Behavioral Health Integration: Considerations for Aligning Federal and State Policy. https://med.fsu.edu/sites/default/files/userFiles/file/Promoting_Integration_State%20Health%20Policy%20Briefing.pdf
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