Outpatient Psychotherapy Plan Design, Managed Care, and a Point of Service Triple Option

As outpatient psychotherapy coverage in the form of managed care health plan mental health benefits has become widespread, so have reports in the professional literature about consumer and therapist losses: (1) consumer loss of choice in selecting an outpatient therapist, (2) therapist’s loss of access to health plan treatment reimbursement, (3) consumer and therapist loss of influence over the nature and direction of therapy, and (4) loss by both of control of therapy duration. These losses are particularly disturbing given findings that a trusting relationship between consumer and therapist is the best predictor of therapeutic success. Several methods provided multiple kinds of evidence about the losses and possible remedies. Following a literature review, I designed an outpatient therapy plan based in a point-of-service approach, calculated a premium-cost neutrality feasibility study, and held a focus group of experts from stakeholder groups. I used three Likert scales (to catch similarities and differences in preference and priority emerging among the participants), idealized system design imaging (to explore the roots of need and design as separate from present practicalities), and qualitative transcript study (to categorize and analyze what was spoken). The focus group modeled needed collaborative cross-stakeholder dialogue. The focus group agreed that losses described in the literature were significant and that a Point-of-Service Triple Option (POSTO) outpatient mental health plan design could help address them. Using a Point-Of-Service approach, at the time the covered consumer needs outpatient psychotherapy service, the POSTO plan allows him/her to choose a therapist from among three sources: an HMO panel, a large PPO panel, and all other licensed therapists. Each level’s different therapist discounts and consumer co-payments aim for cost-neutrality, in which costs would not be prone to increase for the plan which integrates the POSTO approach into its offerings. This study and an expert’s independent underwriting study also confirmed that it is feasible to produce POSTO plan cost-neutrality in comparison to existing plans. Nearly unanimously, group participants recommended six ways to improve outpatient psychotherapy plan design: stimulating consumer understanding of mental health; encouraging prevention and healthy lifestyles; studying and treating the whole person and the mind-body interaction; increasing all parties’ health plan cost knowledge; overseeing care quality; and understanding special populations’ needs. Consumers could be better taught to understand their mental health needs and to choose appropriate therapists. Good “fit” between consumer and therapist could abet therapeutic success. Therapists could be compensated (by health plan and consumer, according to plan) for covered treatment.