RESUMO
Many models of managed care have been criticized as inflexible and intrusive, including those in which decisions about level of care are made by third-party reviewers, in-house staff, or other clinicians not involved in the patient's treatment. The treatment-team model of managed care, which has been implemented in the emergency psychiatric service of a midsized, non-profit community hospital in a metropolitan area, addresses these criticisms. Major features of the model are in-person assessment by a clinician who acts as the managed care agent; immediate accessibility of this clinician; referral services with a broad range of intensity, including crisis intervention; and participation of the managed care clinician on the treatment team. The advantages of this model include the incentive to employ qualified managed care clinicians and an increased ability to provide individualized services. Limitations of the model include the diffusion of decision-making power within the treatment team, the potential for overuse of emergency services by primary providers, and the potential for the managed care agent to lose decision-making power due to personal or systems issues.