5089.0: Wednesday, November 15, 2000 - 12:48 PM

Abstract #17632

Behavioral health care in managed care organizations: Entering and continuing in specialty treatment

Constance M. Horgan, ScD, Deborah W Garnick, ScD, Dominic Hodgkin, PhD, Elizabeth L. Merrick, PhD, MSW, Kathleen C Skwara, MPH, David Goldin, MA, and Robert Cenczyk. Schneider Institute for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02454, 781-736-3916, horgan@brandeis.edu

Access to mental health and substance abuse services is an important and multi-faceted issue. Within managed care organizations (MCOs), behavioral health care can be managed and delivered in a variety of ways. MCOs' approaches to facilitating patient entry into specialty care, and authorizing ongoing treatment, can have major implications for enrollees' access to treatment. We surveyed 400 MCOs in 60 market areas which were previously selected for RWJ's Community Tracking Study to be nationally representative, and achieved a response rate of over 90%. MCO executives and clinical directors were asked about their 1999 behavioral health contracting arrangements, benefit structure, staffing, entry into treatment, utilization management, and treatment processes. This paper reports on access-related findings including entry routes into specialty treatment, preauthorization and ongoing utilization management approaches, and personnel involved in treatment entry and assessment. We also examine how these delivery system features vary for MCOs that carve out behavioral health to specialty vendors versus provide behavioral health services internally.

Learning Objectives: At the conclusion of the presentation, the participant should be able to demonstrate knowledge of current MCO arrangements for entry into specialty behavioral health treatment as well as for authorization of continuing care

Keywords: Managed Care, Access

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA