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Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-01-2006

Managed Care Organizations’ Use of Treatment Management Strategies for Outpatient Mental Health Care

Authors: Elizabeth Levy Merrick, Constance M. Horgan, Deborah W. Garnick, Dominic Hodgkin

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 1/2006

Abstract

A nationally representative sample of managed care organizations was surveyed (response rate=92%) regarding use of treatment management techniques for outpatient mental health care in their commercial products in 1999. Bivariate tests and logistic regression models were used to examine the relationship between product type, behavioral health contracting arrangement and treatment management techniques (prior authorization, standards for time to initial appointment, concurrent review, standards for follow-up after discharge, case management, practice guidelines). Prevalence varied from 43% to 87% depending on the technique. HMO products and products with specialty behavioral health contracts were more likely to use the techniques. Product type and contracting arrangement had independent effects.

We used the Community Tracking Study Follow-back Survey definitions for product type as follows:

HMO: A product in which enrolled individuals are provided health care services by a network of affiliated providers. Services provided to enrollees outside the network are generally not covered, other than for some specialized services or in emergencies.

POS: A product in which enrollees may select in-network or out-of-network physicians at the “point-of-service” usually with significant differences in coinsurance or deductibles. Some POS products are also referred to as “open-ended” HMOs or “triple option” plans.

PPO: A product in which enrollees are given a financial incentive to use a “preferred” network of providers, usually through differences in coinsurance or deductibles.

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Title: Managed Care Organizations’ Use of Treatment Management Strategies for Outpatient Mental Health Care
Authors: Elizabeth Levy Merrick
Constance M. Horgan
Deborah W. Garnick
Dominic Hodgkin
Publication date: 01-01-2006
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 1/2006
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-005-0024-0

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