Deborah W. Garnick, PhD¹, Constance M. Horgan, ScD¹, Elizabeth L. Merrick, PhD, MSW¹, and Dominic Hodgkin, PhD². (1) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA 02493, 781 736-3840, garnick@brandeis.edu, (2) Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454

Quality of specialty behavioral health services depends on health plans’ ability to select and retain providers who have appropriate training, experience, and credentials. A national survey on alcohol, drug abuse and mental health services collected data for 2003 from over 400 health plans in 60 market areas, resulting in national estimates of health plans’ policies for maintaining a provider network. In this paper, we report 2003 findings on factors used in selecting a network (e.g., credentials, professional association membership), how often provider databases are updated, the use and content of provider satisfaction surveys. We also compare selected findings to the 1999 round of the survey (response rate=92%) that found among managed care plans with carve-out contracts, over 90 percent delegated responsibility for network management. Among those with carve-out contracts, over 90 percent used direct verification of licensure, history of liability claims and need for coverage in specific geographic regions in decisions about selecting and retaining providers while approximately two thirds used profiling of providers’ utilization rates. We focus on differences by managed care product type and by whether plans contract with managed behavioral health care organizations, as these variables were associated with different management approaches in 1999. These results have important implications for understanding how managed care plans approach the task of offering specialty services. Because most behavioral health services for enrollees with commercial insurance are offered through managed care plans, understanding how these plans relate to their professional labor force is crucial for understanding variations in quality of care.

Learning Objectives: At the conclusion of the session, participants will be able to

• Identify the range of factors that health plans use to select provider networks and assess provider satisfaction.
• Describe the prevalence of selected approaches to network management.
• Describe how prevalence of methods varies depending on product type and contracting arrangement.

Keywords: Contracting, Managed Care

Presenting author's disclosure statement:
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.