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Clinical skills for the 1990s: six lessons from HMO practice.

Clinical practice in health maintenance organizations (HMOs) currently has many of the features that will become increasingly common in the managed-care environment in which mental health treatment will be provided in the 1990s. HMO policies calling for cost containment, attention to outcomes, practice audits, and treatment guidelines create distinctive demands on clinicians regarding their focus of attention, clinical stance, and professional role. The author identifies six crucial skills that can help clinicians meet these demands effectively: population-oriented practice management, population-oriented program development, ability to apply an adult developmental model, command of a broad repertoire of methodologies, ethical analysis, and advocacy. He uses brief case examples to illustrate how these skills may be used in managed-care settings.