Negotiating with the partners: a role of the HMO mental health director

Abstract

The mental health director in a health maintenance organization must successfully negotiate with a number of "partners" in the community and within the HMO in order to deliver high-quality services in a cost-effective fashion. These partners are companies whose employees are members, the members themselves, the HMO's primary care professionals, the mental health professionals, and the HMO administration. In addition, the models of treatment prevalent within a community constitute an intangible partner. Based on his experience in a mixed fee-for-service and HMO mental health department, the author describes negotiations of some difficult issues, which include whether patients can bypass their primary care physician and refer themselves to the mental health department, establishing co-payment rates for outpatient visits to prevent overutilization of mental health services, and dealing with companies who disagree with the HMO's treatment modalities. Although at times compromises are necessary, sometimes the mental health director must maintain a rigid position in order to protect a cost-effective program and promote smooth delivery of services.