Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114026

Constance M. Horgan, ScD¹, Elizabeth L. Merrick, PhD, MSW¹, Deborah W. Garnick, ScD¹, and Dominic Hodgkin, PhD². (1) Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA 02454, 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

The ways that health plans manage access to specialty substance abuse services have important implications for treatment by influencing entry into care. A 2003 survey on behavioral health services collected data from 368 health plans in 60 market areas, resulting in national estimates of how health plans structure treatment entry. We report 2003 findings (N=368, 83% response rate) on gatekeeping and utilization management and compare selected findings to the 1999 baseline round of the survey (N=434, 92% response rate). We found that a quarter of products require primary care physicians to use standard screening questionnaires to detect substance abuse problems. For all types of inpatient or residential substance abuse care, most products require prior authorization. Over half of plans also require prior authorization for outpatient treatment. To access outpatient care: 44% of plans require the enrollee or provider to contact the plan, 9% require the enrollee to call the phone center, and 5% require the provider to call. Since 1999, a higher percentage of plans have standards for maximum wait time to the initial appointment. There are differences by product type and contracting arrangement. These results have important implications for understanding initial access to substance abuse care. Variations in arrangements are important to employers in choosing health plans and to health plans in terms of deciding whether to contract out behavioral health services. Ultimately, to identify the impact of evolving systems on how enrollees' enter treatment, it is critical to understand the structure and processes through which services are provided.

Learning Objectives:

· Describe the prevalence of several gate-keeping and utilization management approaches for substance abuse treatment. · Summarize changes in prevalence of gatekeeping and selected utilization management approaches since 199
• · Describe how product type and contracting arrangements affect the use of gatekeeping and utilization management.

Keywords: Substance Abuse Treatment, Managed Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation