Objective: Estimate effects of a large managed behavioral healthcare organization's (MBHO) "products" on levels and amount of care authorized for alcohol-problem patients. Method: The data were 8897 valid episodes of care authorization; analyses were confined to alcohol abuse/dependency cases without co-morbidities. Levels of care were grouped into (1)acute/inpatient, (2)subacute/residential, (3)partial hospitalization/intensive outpatient, and (4)traditional outpatient. Multinomial regression equations were estimated for each treatment level; separate linear regressions analyzed quantity of care. Product type, state, and provider participation in the MBHO’s preferred network were included in the analysis as explanatory variables. Age, sex, and alcohol-dependency were included as control variables. Results: Patients covered by the MBHO’s HMO and Medicaid HMO were less likely to be authorized for acute/inpatient care. Patients with policies for which the MBHO bore no financial risk were likely to be authorized for more acute care for more days, but fewer outpatient sessions. Across products, patients with more dependency were authorized for more inpatient and residential days. Patients treated by providers not in the MBHO’s preferred-network were less likely to receive high levels of care. Residents of Pennsylvania, a state with mandated minimum levels of substance abuse care and which follows ASAM criteria for placement, were more likely to be authorized across a fuller continuum of care. Conclusion: While authorization and MBHO-risk partly reflect the "richness" of the benefit, the MBHO authorized lower levels of care for alcohol treatment when there was some financial risk and when operating in states that did not require mandated care minimums. NIAAA Grant R01-11359.
Learning Objectives: Attendees will (1) able to identify 4 levels of alcohol treatment services authorized by managed care and (2) be able to discuss how risk and regulation influence the mix of services authorized
Keywords: Managed Care, Substance Abuse Treatment
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.