Modifying the Impact of Managed Care
Abstract
Modifying of ManagedPaul S. Appelbaum,the ImpactM.D.As pressures mount on health insurers to restrain the rate of increases in premiums, more insurance plans are turning to intensive prospective and concurrent review ofservices, a strategy that has come to be called managed care. Traditionally, insurance plans have allowed patients substantial freedom ofchoice in the selection of providers and have granted clinicians nearly complete discretion in the provision of care. Conversion of such plans to a managed care format can create enormous disruptions for patients and professionals alike. This report describes the difficulties attending the conversion to managed care of a large Massachusetts health plan, and how the intervention of organized psychiatry led to changes in the planâs design and procedures that helped to protect the interests of all parties. Bay State Health Plan was organized by a group of Massachusetts physicians in the 1 970s as a broadbased preferred provider organization. All physicians in the state were invited to join the program on payment of a contribution-typicallyDr. Appelbaumprofessor partment versity Center, andis A. F. Zeleznik chairman of the deat the UniMedicalof psychiatry of Massachusetts55 Lake Avenue North, Worcester, Massachusetts 01655. At the time of the events described president Psychiatric Sharfstein,