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Managed care, Mental health, Health promotion, Health economics, Business, Health policy, Health administration, Nursing, Family medicine, medicine.medical_specialty, medicine, Health care, business.industry, and Health education

RAND conducted three studies examining issues surrounding mental health benefits under managed care. The studies focused on the costs of mental health services under managed care and the implications of the 1996 parity legislation for cost and benefit design.

Psychiatry and Mental health, Managed care, Mental health care, Medicine, business.industry, business, Psychotherapist, Mental health, Public health, medicine.medical_specialty, Claims data, Ambulatory, Pharmacotherapy, and Retrospective design

OBJECTIVE: This exploratory study examined utilization and costs among depressed patients in two treatment models—integrated treatment, in which psychotherapy and pharmacotherapy were provided by a psychiatrist, and split treatment, in which pharmacotherapy was provided by a psychiatrist and psychotherapy by a nonphysician psychotherapist. METHODS: A quasi-experimental retrospective design was used to compare claims data from a national managed mental health care organization for 191 patients in integrated treatment and 1,326 in split treatment. RESULTS: During the 18-month study, patients receiving integrated treatment used significantly fewer outpatient sessions and had significantly lower treatment costs, on average, than those in split treatment. Integrated treatment appeared to be associated with a pattern of utilization characterized by frequent treatment episodes in contrast to that of split treatment, which was characterized by more sessions with fewer breaks of 90 days or more. CONCLUSIONS: The r...

General Psychology, Quality management, Professional psychology, Quality of care, Applied psychology, Psychology, and Health personnel

General Social Sciences, Statistics and Probability, Multilevel model, Psychotherapist, Clinical Practice, Artificial intelligence, business.industry, business, Computer science, Benchmarking, Bench marking, Machine learning, computer.software_genre, and computer

Psychotherapy research has been interested in understanding the variability observed among therapists with regard to their treatment effectiveness. An important initial step towards understanding the source of the differences is to reliably identify therapists that are effective. The current paper thus proposes a method for benchmarking therapists against predetermined criteria of effectiveness which could be conducted using any standard statistical package. Basic steps include (a) creating benchmark(s), (b) determining a prior the numerical criteria that constitute as “effective” based on the benchmark(s), (c) calculating pre-post effect sizes as an indicator of effectiveness at the case level using statistical adjustments so as to best match clinical (and other) differences among cases, and (d) statistically benchmarking the therapists using a random-effects hierarchical linear modeling. An example is provided that highlights the number of therapists who would be classified as effective based on various numerical criteria and confidence levels.

Public Health, Environmental and Occupational Health, Health Policy, Physical therapy, medicine.medical_specialty, medicine, business.industry, business, Outcome measures, Managed care, Quality management system, Behavioral healthcare, Clinical Practice, Treatment outcome, and Interactive voice response

This study examined the use of outcome reports sent to clinicians by a managed behavioral healthcare organization to monitor patient progress and its relation to treatment outcome. Results showed that clinicians who reported using outcome information had patients who also reported greater improvement at 6 months from baseline. Improvement per session was greatest among patients whose clinicians reported reading the outcome report and using outcome measures in their clinical practice. Using baseline and ongoing measures to assess patient improvement can provide clinicians with feedback during treatment, which may lead to better clinical outcomes and enable quality management systems in managed care to flag high-risk cases and identify failure of adequate improvement.

Psychiatry and Mental health, Family medicine, medicine.medical_specialty, medicine, Healthcare use, Prevalence, business.industry, business, Substance use, Mental health, Medical comorbidity, Specialty, Comorbidity, medicine.disease, Functional disability, and mental disorders

Comorbid medical and behavioral conditions are associated with greater functional disability, increased morbidity and suicide-related mortality, and greater total healthcare use and costs.1,2 Mental and substance use disorders are twice as likely to occur among the chronically ill, with depression being the most common comorbid condition among medical patients (approximate prevalence of 25%).3 Although there is evidence of bidirectionality of medical and mental health conditions,4 research on their comorbidity has focused primarily on prevalence rates of

Psychiatry and Mental health, Managed care, Schizophrenia, medicine.disease, medicine, Population, education.field_of_study, education, Major depressive disorder, Mental health, Health care, business.industry, business, Psychiatry, medicine.medical_specialty, Performance measurement, and Population based

This paper describes the development of—and early efforts to validate—guidelines that indicate average amounts of service expected to be used by a population of patients with a given disorder who are served by a comprehensive mental health system. These guidelines address expected service use by individuals in 55 diagnostic groups. The purpose of these guidelines is to provide a gauge for evaluating the amounts of service being delivered by managed care organizations. Three population-based guidelines (for attention-deficit/hyperactivity disorder, major depressive disorder, and schizophrenia) are compared to actual amounts of service delivered to enrollees in large behavioral health care systems.

General Medicine, Mental health, Public relations, business.industry, business, Research center, Senior management, Health economics, Universal design, Managed care, Medicine, Health care, and Health services research

Background: The rise of managed behavioral health care in the United States was accompanied by reductions in costs, which has shifted the policy debate from concerns about rising costs to questions of universal access, mental health benefits at parity with medical benefits and quality of care. To meet these new challenges, managed care organizations, the purchasers of health care and academic services researchers must work together in new ways. Aims of the Study: This paper discusses collaborative efforts between a for-profit managed care firm, academia and purchasers of health care coverage to study parity for mental health and substance abuse and how this effort has become part of a research strategy to inform policy. Historical, strategic and methodological issues are presented. Methods: Case Study. Results: Although the benefits from cooperative research are substantial, there are severe hurdles. Managed care organizations often have data that could answer pressing policy questions, yet these data are rarely used by researchers because it is difficult to obtain access and because analyzing the data requires computing facilities and skills that are not common in health services research. In turn, managed care organizations can learn how to design and implement more informative data systems that eventually lead to more cost-effective care, but there often are more immediately pressing business considerations and sometimes resistance to outside scrutiny. Important features that made this cooperation successful include strong support from the senior management in the company, including complete access to their extensive databases, and established funding for a managed care research center by the National Institute of Mental Health. Conclusion: This paper illustrates the potential of collaborative research. New research challenges, such as the linkages between quality and cost-effectiveness in actual practice settings, can only be met successfully if we build alliances among payors, managed care companies and academic researchers. Copyright © 1999 John Wiley & Sons, Ltd.

Health Policy, Mental health care, Mental health, Ambulatory care, MEDLINE, Medicine, business.industry, business, Health care, Cost reduction, Managed care, Health economics, Medical emergency, medicine.disease, and health care economics and organizations

This paper tracks access, utilization, and costs of mental health care for a private employer over nine years during which mental health benefits were carved out of the medical plan and managed care was introduced. Prior to the carve-out, mental health costs increased by around 30 percent annually; in the first year after the change, costs dropped by more than 40 percent; in the six follow-up years, costs continued to decline slowly. This cost reduction was not attributable to decreased initial access, as the number of persons using any mental health care increased following the change. Instead, the cost reduction was the result of (1) fewer outpatient sessions per user, (2) reduced probability of an inpatient admission, (3) reduced length-of-stay for an inpatient episode, and (4) substantially lower costs per unit of service.

Health Policy, Mental health, Managed care, Nursing, Health care, business.industry, business, Medicine, Insurability, Health organization, and Descriptive research

Debate continues about the cost and use of mental health services under managed care, as legislators consider various “parity” bills. This descriptive research replicates, broadens, and expands previously published case studies of single employers' data on cost and treatment prevalence in a large, diverse, national sample whose varied point-of-service benefits were provided by thirty employers representing multiple industries. Of those covered, 59,005 received treatment over the seven years studied. Of particular note is the pattern of increased use, increased care within the managed behavioral health organization network, and long-term cost reductions.

Public Health, Environmental and Occupational Health, Medicine, business.industry, business, Mental health, Managed care, Mental illness, medicine.disease, Medical model of disability, Health care, Psychiatry, medicine.medical_specialty, Occupational medicine, Cohort, and Salud mental

The cost of mental illness to employers has been well documented; however, efforts to effectively reduce the costs of psychiatric disability are adversely affected by the fragmentation of health care services. This report is a case study of a program in which a managed behavioral health care organization managed the psychiatric disability of a telecommunications company, Compared with a non-random cohort of claimants not managed under the pilot, the duration of disability was reduced by 23% (17.1 days). Patient and provider satisfaction with the program was high. This study illustrates the potential for effectively reducing the cost of psychiatric disability and the challenges in coordinating health care.

Psychiatry and Mental health, Ambulatory care, Family medicine, medicine.medical_specialty, medicine, Health organization, Outpatient psychotherapy, Appropriate use, business.industry, business, Mental health care, Managed care, Mental health, Psychiatry, and Specialty

OBJECTIVES: This study was a first step in explicitly attempting to open, at least partially, the "black box" of specialty managed mental health care by examining qualitative as well as quantitative aspects of managed outpatient mental health treatment. The Goal Focus Treatment Planning and Outcomes (GFTPO) program was studied as an example of a relatively simple, patient-specific, structured educational intervention with a modest capacity to affect practice patterns and care over time among network clinicians. METHODS: Four years of data from an enhanced care management program (N=28,741) designed to facilitate focused, goal-oriented, accountable outpatient psychotherapy and appropriate use of medications were used to illustrate what was actually done in one large national managed behavioral health organization. Random samples of persons from seven matched pairs of GFTPO (N=17,752) and non-GFTPO (N=10,989) employer groups from 1995 to 1998 were studied in a quasi-experimental design. The effects of GFTPO...

Psychiatry and Mental health, Complaint, Patient satisfaction, Family medicine, medicine.medical_specialty, medicine, Perception, media_common.quotation_subject, media_common, Managed care, business.industry, business, Concurrent Review, Ambulatory care, Public health, Ambulatory, and Psychiatry

OBJECTIVE: A common complaint about managed care is that treatment decisions of patients and providers are frequently altered by concurrent review of ongoing outpatient treatment. The objective of this study was to examine this perception from the perspectives of patients and providers. METHODS: A total of 190 patients and their providers were surveyed about the reason that outpatient treatment was terminated. The sample was randomly drawn from completed outpatient treatment episodes of a large national managed behavioral health organization. RESULTS: In more than three-quarters of the cases, outpatient treatment ended because patients and providers agreed that treatment goals were partially or completely met. Only 5 percent of patients and 3 percent of providers said that treatment ended because the managed care organization denied ongoing treatment. Agreement between patient-provider pairs was generally poor regarding the perceived reason for termination, except when termination was attributed to concur...

General Medicine, Family medicine, medicine.medical_specialty, medicine, Managed care, Health care, business.industry, business, Substance abuse, medicine.disease, Nursing, Legislation, Indemnity, Ambulatory care, Mental health, and Self-insurance

Background: In the United States, insurance benefits for treating alcohol, drug abuse and mental health (ADM) problems have been much more limited than medical care benefits. To change that situation, more than 30 states were considering legislation that requires equal benefits for ADM and medical care (‘parity’) in the past year. Uncertainty about the cost consequences of such proposed legislation remains a major stumbling block. There has been no information about the actual experience of implementing parity benefits under managed care or the effects on access to care and utilization. Aims of the Study: Document the experience of the State of Ohio with adopting full parity for ADM care for its state employee program under managed care. Ohio provides an unusually long time series with seven years of managed behavioral health benefits, which allows us to study inflationary trends in a plan with unlimited ADM benefits. Methods: Primarily a case study, we describe the implementation of the program and track utilization, and costs of ADM care from 1989 to 1997. We use a variety of administrative and claims data and reports provided by United Behavioral Health and the state of Ohio. The analysis of the utilization and cost effect of parity and managed care is pre‐post, with a multiyear follow-up period. Results: The switch from unmanaged indemnity care to managed carve-out care was followed by a 75% drop in inpatient days and a 40% drop in outpatient visits per 1000 members, despite the simultaneous increase in benefits. The subsequent years saw a continuous decline in inpatient days and an increased use of intermediate services, such as residential care and intensive outpatient care. The number of outpatient visits stabilized in the range of 500‐550 visits per 1000. There was no indication that costs started to increase during the study period; instead, costs continued to decline. A somewhat different picture emerges when comparing utilization under HMOs with utilization under a carveout with expanded benefits. In that case, the expansion of benefits led to a significant jump in outpatient utilization and intermediate services, while there was a small decrease in inpatient days. Insurance payments in 1996/1997 were almost identical to the estimated costs under HMOs in 1993.