MENTAL HEALTH: HMOs Push For Group Therapy
HMOs are "pushing group therapy to treat depression, anxiety, addiction and other ailments for which patients have long sought one-on-one help," prompting some to charge that "the managed care tail [is] wagging the dog" as the interests of bean counters are placed over those of patients. For example, the Wall Street Journal reports, Kaiser Permanente's Northwest division covers "as many as 40 group sessions a year, compared with as many as 20 for individual counseling." And PacifiCare Health Systems Inc. "may start linking group therapy work to performance bonuses." For their part, HMOs "say they are posing an overdue challenge to practitioners to defend the efficacy of expensive one-on-one therapy when it fails to produce results." Some doctors and psychiatrists, however, "say managed care companies may actually be doing patients a favor by nudging them into an effective but underused treatment." But even supporters of group therapy "object to indiscriminate attempts to use it as a quick-fix alternative to individual care." Dr. David Gastfried of Harvard Medical School, a principle investigator of a study that found "cocaine-addicted patients fared significantly better with a combination of individual and group therapy," said, "Cookie-cutter restrictions on individual therapy is not a good idea for recovery" (Jeffrey, 1/11).
Separately, the Wall Street Journal reports that primary care doctors are increasingly "filling the gap in mental health care left by managed care's limits on psychiatric visits," and are stepping up efforts to diagnose and treat depression. These doctors "are ideally poised to monitor patients' psychological well being," as many patients "first experience depression with a cluster of physical problems such as fatigue, headache and disrupted eating or sleeping patterns," the Journal reports. While "better physician training" in mental health diagnosis and the advent of better antidepressants are leading primary care doctors to diagnose more patients with depression, some experts are worried there is a "gap in skills" between "commitment and care." Dr. Jerrold Rosenbaum, director of psychopharmacology at Massachusetts General Hospital, said "given the huge numbers of undiagnosed people with depression, there's value" in having primary care doctors' help, but they must improve their skills. These doctors often fail to tell depressed patients how long it will take medication to "kick in" and are not always "vigilant about follow-up," according to Rosenbaum (Chase, 1/11).