Managing Managed Care Through Accreditation Standards‪.‬

The emergence of managed care has significantly influenced the financing and delivery of mental health and health care services. Having survived a long tradition of social and economic policies designed to limit services and contain costs, the social work profession is uniquely suited to respond to the conditions of managed care. Social work practice has long been situated in complex organizations and host settings such as schools and hospitals. This organization of services has forced the social work practitioner to develop skills in navigating systems to meet conflicting needs, expectations, and goals. In addition, the social worker in an organization has had to comply with multiple layers of regulations and standards. Managed care has not changed this essential feature of social work practice. Working effectively in a managed care environment, like any other, requires that the social worker know how to negotiate the regulations, standards, processes, and structures in use. For the purposes of this article, managed care is a collective term used to describe a variety of strategies implemented by insurers to control health and mental health care costs. These efforts generally fall along two dimensions. The first entails establishing policies and procedures that regulate benefits, payments, and providers. The second strategy involves employing gatekeepers to review and authorize services at various points (Wagner, 2001). Social workers interface with managed care organizations (MCOs) directly as providers and also as employees of mental health, health care, and social service agencies providing services to managed care clients.