Prevention and Managed Care

It was important to see APA President Daniel Borenstein, M.D., emphasize prevention in his column “Promotion of Mental Health” in the January 19 issue. It shows we are interested in the well-being of the entire population and has little that can look like self-interest. But guess what has not forgotten prevention and, in fact, requires it for NCQA accreditation: Managed care. There are many elegant prevention programs in process. There is also some documentation of success, at least in the general medical area. For example, 70 percent of women HMO patients receive recommended mammograms, compared with 28 percent in fee-for-service programs. In some ways, managed care is returning to its roots as described in the name of health maintenance organizations. Maybe organized psychiatry can learn something from the managed care companies.