managed care pressures

In response to managed care pressures, five years ago your child and family services agency dramatically increased the amount of time practitioners had to spend filling out forms on each case, including the provision of details about diagnoses and other information bearing on whether and how long services for each case were eligible for reimbursement from managed care companies.

Discuss the specific ways in which this development might create special problems in analyzing existing agency statistics regarding historical trends in the types of diagnoses of clients served by your agency, the nature and amount of services provided, and client background characteristics.

Required Textbook:
Krysik, J.L., & Finn, J. (2010). Research for effective social work practice (2nd ed.). New York:
Routledge/Taylor & Francis. (ISBN# 978-0-415-80506-3)

Analyzing existing agency statistics in response to managed care requirements for paperwork can become skewed when analyzing it in the historical sense.  The increase in hours that accumulate while filling out required forms equates to the decrease in hours spent with patients.  That decrease then changes the amount of patients being treated, affects outcome statistics, and reduces the validity of historical analysis data due to this added variable.  A comparison analysis in the historical sense of an agency’s overall effectiveness, clientele and delivery of services does not measure what the intent of the analysis would seek to measure.  It would record a diminishing return on services based on the increase of administrative duties instead of agencies and social workers’ skills and effectiveness.  Further, the client background statistics could also be skewed because of eligibility requirements and stringent guidelines through managed care.  For example, a person who only has an insurance allotment of six sessions with a social worker but is in need of more sessions can be left untreated due to the expense.  The implication of these limited sessions can also give the data a measurement that looks like a certain demographic of people require less treatment, while others would be considered in greater need of services.  This affects the statistics from data taken of various groups and their specific biopsychosocial needs.  As a result, social policies are created and repealed based on this statistical evidence that has been generated by problematic data.  As outcome evaluation is crucial to political decision making, the implications for adding variables that affect or incorrectly measure agency statistics can have far reaching consequences at all levels of society (Krysik & Finn, 2010).
Krysik, J.L. & Finn, J. 2010. Research for effective social work practice.  New York, NY: Routledge.

Managed care has changed the way that social work services are provided and documented. It may be that only certain diagnoses qualify for treatment, and the length of treatment and method of treatment are dictated by the managed care program. “Changes in payment incentives or administrative controls due to managed care may affect provider decisions about the mix and intensity of service offerings” (Olmstead, White, & Sindelar, 2004, p. 321). If a social service agency has been given specific guidelines on what diagnoses qualify for treatment, and specify the length of treatment in order to be paid for services, the agency would be forced to customize assessments and treatment plans to meet those guidelines. The assessments and treatment plans prior to the change in managed care requirements may have used different criteria in diagnosing and treating individuals. Having knowledge of what is or is not covered under managed care may prompt a social worker or agency to tailor assessments and treatments to meet those guidelines.  It would seem obvious that time spent on additional paperwork to ensure coverage for clients would take away time from direct service with the clients potentially affecting the outcome of services provided.

It would be problematic in conducting an analysis of historical trends within this agency due to the change in the way services are being provided pre and post managed care requirements. The directives from the managed care company changed agency practice; so any changes in client outcomes, services, or diagnoses could be attributed to those directives.  Trends that occurred before the agency made any changes in practice could not be compared to trends that happened after those changes were made. For example if there were a decrease in the average number of clients diagnosed with depression after the changes in practice as a result of the managed care guidelines, what could that decrease be attributed to? It could simply be that the managed care company will not cover treatment for depression. Or it could be that practioners diagnosed depressed clients with something else that is covered under managed care in order to get that particular client services.  In essence the longitudinal analysis would be comparing two different types of services.

Olmstead, T., White, W.D., & Sindelar, J. 2004. The Impact of Managed Care on Substance Abuse Treatment Services. Health Services Research, 39(2), 319-344. doi: 10.1111/j.1475-6773.2004.00230.x


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