Based on two years' work in an inner-city psychiatric clinic serving 50,000 members of a health maintenance organization (HMO), the author presents ten guidelines for the many clinicians now attempting to maintain sound psychiatric practice within the limitations of an HMO. The guidelines suggest that HMO psychiatrists perform thorough intake evaluations that facilitate triage to specific treatments, negotiate treatment contracts with patients, focus on patient requests, enter a problemsolving partnership with patients, facilitate termination, use least costly treatments, use support groups, transform economic limitations into therapeutic tools, appeal individual cases requiring extensive treatment, and undertake research.
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