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Book Reviews   |    
Concise Guide to Managing Behavioral Health Care Within a Managed Care Environment
Reviewed by Jay M. Pomerantz, M.D.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.9.1300
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by Michael Isaiah Bennett, M.D.; Washington, D.C., American Psychiatric Publishing, Inc., 2002, 104 pages, $24.95 softcover

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Michael Isaiah Bennett has written a useful small book that can be read in less than two hours. Although brief, Managing Behavioral Health Care Within a Managed Care Environment is not superficial. The references are well chosen and abundant, so any major point can be followed up by an interested reader. I particularly liked the illustrations of exactly what words might be said in a given circumstance to the patient, the managed care company, or the clinician. Sometimes the author illustrates his point by providing a sentence or two demonstrating the wrong way to address the same issue. The practical approach and sound advice would be helpful to a newcomer to the confusing world of managed care. The basic premise is that limitations on resources for psychiatric care are not necessarily bad—patients and therapists must learn to cope with limits.

Yet something is missing from this book, and it does not stem from the book's brevity. The author seems to have made a deliberate choice to focus on what is right with managed behavioral health care rather than its problems. Because Bennett has worked in both the public and the private sectors, as a clinician and as a physician advisor to a managed care organization (just as I have), he must know the other side of managed behavioral care. Sometimes, the cost savings that clinicians and administrators force on patients and their families end up as profits for investors or chief executive officers rather than being applied to the care of other patients. Next year's budget for behavioral health may be cut further if costs are contained this year. Managed care companies know that barriers to care not only reap short-term financial benefits but also drive costly patients with mental illness to competitors.

The book also makes little mention of carve-out companies and the practical questions that arise around them. For example, should clinicians seek to work for all of them? Is it ethical to belong to a network to see ongoing patients, yet refuse new patients from that organization (while accepting new patients from better payers)? Who is responsible for "phantom networks"—irresponsible psychiatrists, or managed care companies who insist on much paperwork and low clinician reimbursement? What about managed care-driven split therapy, whereby a psychiatrist works with psychotherapists selected by the managed care company—does one accept all arrangements? None of these messy issues appears in the book, although there is a good discussion about how to go about appealing managed care denials.

In short, Bennett has written a good book for medical students and beginning psychiatric residents. Clinicians, both within and outside of these organizations, must behave ethically, and the author illustrates how to do so. Yet acting ethically in a sometimes-questionable environment is addressed incompletely, and that failing leaves this little gem of a book incomplete. Maybe it is a matter of the book's title promising more than it delivers. I believe that Bennett has written "A Concise Moral Guide to Managing Behavioral Health Care Within an Idealized Managed Care Environment."

Dr. Pomerantz practices psychiatry in Longmeadow, Massachusetts, and is an assistant clinical professor of psychiatry at Harvard Medical School in Boston.




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