Characteristics of Mental Health Clinicians Participating in Health Maintenance Organizations (HMOs) and Accepting HMO Patients
Sabine Cassell, Ph.D.
Dr. Sabine Cassell
The Problem With the implementation of managed health care, consumers and clinicians have been faced with increased bureaucracy, as well as potential limitations to covered mental health services. Some mental health clinicians in independent practice have responded to managed care by not participating in HMOs or by not accepting HMO patients.
Previous research has focused on the impact managed care has on clinical mental health care practice. There is a lack of academic research identifying what factors influence these mental health clinicians in their decision whether or not to participate in HMO networks.
The Research Questions In response, this research examined independent mental health providers’ participation in HMOs in south Florida. The study focused on two research questions:
Why are mental health practitioners participating or not participating in HMOs?
Why are these practitioners accepting or not accepting HMO patients?
Methodology and Sample In a cross-sectional survey, 827 independent practitioners in south Florida received a mail survey instrument. Regression analysis and ANOVA were conducted on the 418 responses.
Findings Seven factors were significant in influencing participation: (a) level of HMO reimbursement, (b) benefits, (c) utilization management, (d) time required to collect HMO reimbursement, (e) ethical dilemma, (f) profession, and (g) county.
Four factors were significant in influencing acceptance of HMO patients: (a) ethical dilemma, (b) years of clinical experience, (c) time required to collect HMO reimbursement, and (d) the clinician’s education level.
Recommendations
The relationship between treatment outcomes and the clinician’s education level and clinical experience needs to be examined.
Insurance regulation should require HMOs to list only clinicians who accept HMO patients.
A better working relationship between HMOs and mental health providers is needed.
Research aimed at improving this relationship should focus on addressing ethical concerns, time considerations on getting paid, reimbursement levels, and utilization review processes. All stakeholders would benefit from an improved relationship.
Dr. Sabine Cassell received her Ph.D. in Applied Management and Decision Sciences from Walden University, an M.S. in mental health counseling from Nova Southeastern University, and an A.L.B. in social sciences from Harvard University. She is a member of the American Psychological Association, the Society for Industrial and Organizational Psychology, and the Society of Human Resources, where she attained the SPHR designation. As the founder of an organizational development/human assets firm, Cassell promotes the leadership development of women and minorities in organizations and communities. She can be reached at scassell@scmailbox.com.
