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.
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Notes
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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Acknowledgments
This research was supported by grants from the National Institute on Drug Abuse (Grant #R01 DA10915), the National Institute on Alcohol Abuse and Alcoholism (Grant #R01 AA10869), and the Center for Mental Health Services in the Substance Abuse and Mental Health Services Administration. The authors thank all of the respondents for their participation in this survey. The authors acknowledge the contributions of Robert Cenczyk, Della Faulkner, David Goldin, Will Lusenhop, Frank Potter and all of the project team at Mathematica Policy Research, Inc., Grant Ritter, Kathleen Carley Skwara, and Galina Zolotusky, and thank Michele King for manuscript preparation assistance. The authors also thank Laurence Baker for sharing his HMO enrollment data.
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Merrick, E., Horgan, C., Garnick, D. et al. Managed Care Organizations’ Use of Treatment Management Strategies for Outpatient Mental Health Care. Adm Policy Ment Health 33, 104–114 (2006). https://doi.org/10.1007/s10488-005-0024-0
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DOI: https://doi.org/10.1007/s10488-005-0024-0