Magazine article Family Therapy Networker

The Business of Therapy: The Bottom Line: A Primer on Managing Managed Care

Magazine article Family Therapy Networker

The Business of Therapy: The Bottom Line: A Primer on Managing Managed Care

Article excerpt

PRIVATE PRACTITIONERS WHO WANT TO SURVIVE TODAY must know how to work smarter, and market and provide quality customer service. It is essential either to have someone who helps you keep your eye on the bottom line or to educate yourself about running a business. Doing both is the safest strategy.

It's increasingly clear to everyone that if you're starting from scratch in today's marketplace, the first step to establishing a solid practice is obtaining contracts with managed care companies. To approach that task systematically, draw up a list of the large employers in your area (the chamber of commerce in most cities has an annual directory with their members' names, size, addresses and telephone numbers). Call their human resource office and ask them who their insurance carrier or carriers are and who their managed care company for mental health is. It is important to stress that the managed care is for mental health, because there often will be different managed care companies for medical and mental health. Once you have this information, you can call the managed care company and ask for the provider relations department. They will probably quiz you about your degree, how long you have been licensed or certified, how many times suit has been threatened or filed against you (There should be none if you want to get a contract!), and how quickly a client can see you after an initial contact. Once that initial questioning is over, they will check their computer files to see if they need providers of your specialty in your city. Managed care companies like to hear buzz words like "goal-focused," "time-limited" and "outcome-directed." They will also be interested in the names and phone numbers of other managed care companies and employee assistance programs with whom you have worked.

If the managed care company indicates they are not taking any applications in your city and you already have a client insured with them, ask the client to call the provider relations department, ask for the person who just turned you down, and inform them of the fine therapy he or she is receiving and the time, money and trouble it would take to switch therapists.

When the long, torturous application from the managed care company finally comes in the mail, approach filling it out as you would a job interview as an opportunity to sell yourself and your professional expertise. Emphasize your strengths and check off as many specialties as you honestly can. (This increases your chance of actually getting a referral before the year 2001.) When a prospective client calls the managed care company, they check their data base before they make a referral. We know that some people recommend that therapists carve out a small, distinctive niche for themselves, but only if they think that niche is in great demand.

Managed care companies have a basic distrust of therapists who are in solo practice. They are looking for people with their own networks of support and back-up. They will be concerned, for instance, about who will handle an emergency for you if you are gone for the weekend or can't be reached in the middle of the night. Will your client be able to get in touch with one of your colleagues or will they be calling the managed care company hot line? Holding regular staff meetings or having a supervisor who is a psychologist or psychiatrist is a plus, because that implies that your work will be checked and that you are less likely to make a mistake. Mistakes mean that the client will be suing the managed care company they don't like that.

As everyone knows, managed care companies are looking for providers who use a brief, but effective, model. If you have measured the average length of therapy and done client satisfaction surveys, all the better. We run a sample of 100 clients at least once a year and calculate the average stay and the reported satisfaction with our services, as well as soliciting any recommendations for improvement. …

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