By Cheryl Lani Branson, CSW, Member, Independent Practice and Managed Care Task Force
(May 1996)

In February, the Chapter's Independent Practice and Managed Care Task Force sponsored its first panel/workshop on Managed Care in New York City. The day began with two panels, "An Overview of Managed Care," presented by Carol Katz, and "Legislative Initiatives," given by Gerald Beallor. Following these panels, three workshops were held: "Legal and Ethical Issues," presenter Adrienne Cypress; "Marketing Your Service Products to Managed Care and Non-Managed Care Institutions," presenter Sheila Peck; and "Cultivating Your Relationship with Managed Care," presenter Joan Kuver.

Some key issues and concerns that were addressed were:

• Marketing - Individuals need to develop a niche in order to succeed in the current environment and to define what makes them unique and the only provider of such a service. Press releases, joining local clubs and joining professional societies are just a few ways of increasing visibility.

• Relationship building - It is important once in a network to get familiar with the peer review managers on a personal level and to remember that the goal of managed care is not growth, or cure, but symptom reduction. It is also useful to check fairly frequently to ascertain the number of session one has been allotted by the managed care company.

• Legal and Ethical Issues-With the introduction of managed care into the therapeutic relationship, treatment becomes a three way relationship - between the client, the therapist, and the managed care company. The client ought to be apprised as to what this means, both in terms of confidentiality and in terms of limitations. The therapist is generally contractually obligated to reveal all requested client information to the managed are care companies: Having an attorney look at the managed care contract before the therapist signs it was suggested.

• Mental health, or behavioral managed care companies offer their customers service based on their need as a "medical necessity." What constitutes a medical necessity is different for every company. Some very specific issues that practitioners need to be mindful of: Does the contract allow the managed care company to use your name in marketing itself? Prohibit you from saying anything negative about the company? Can the company terminate you without cause? Can they investigate you? Most companies can ask questions of any sources, at their will, can terminate you from their provider list, and you have no options or rights in ascertaining why you have been dropped from the network.

Managed care is changing the way we perform as clinicians. The Independent Practice and Managed Care Task Force's major tasks are to define the role of social workers, to advocate with both consumers and legislators, and to create mutually satisfying relationships between mental health managed care companies and practitioners. For more information on the Task Force, call Dava Weinstein, (212) 799-0664.