Managing Managed Care Quality Improvement in Behavioral Health (1997) / Chapter Skim
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ACCESS
ACCESS
Pages 168-183
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From page 168... ...
Managed behavioral health care produces savings in several ways, including paying lower prices to providers; reducing the use of inpatient care, especially for substance abuse treatment; and reducing the length of outpatient treatment. A study of mental health and substance abuse in the Massachusetts Medicaid program found that utilization of care changed in accordance with an incentive struc 168
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From page 169... ...
Although some states passed legislation that required that commercial group health care plans include coverage for mental illness and alcoholism, the benefits were limited and many states simply required that coverage be offered (Scott et al., 1992~. Services for drug abuse and dependence were rarely specifically included in health plans (Rogowski, 1993)
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From page 170... ...
Critics of managed behavioral health care plans often focus on the potential for reduced access and undertreatment (Boyle and Callahan, 1995; NCQA, 1996~. The stigma associated with mental illness and substance abuse also contrite' utes to the potential for undertreatment and insufficient access to care (Mechanic et al., 1995~.
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From page 171... ...
Analysis of the access standards proposed for the National Committee on Quality Assurance's Health Plan Employer Data and Information Set version 3.0 (HEDIS 3.0) , and of those currently used by Digital Equipment Corporation and
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From page 173... ...
- ........ ::::::::::::::::::::::::::::::::::-:-::-:-::::::::.::::::::::::::-:::::-:-:-:::::::::::::::::,::::::::,::::::::::::::::-:-:::::-:-:-:-::::::::: ~N-at-l-onal Assscl.a ~-l-on of county Behavloral Health Directors l ::::::::::::::::::::::::::::::::::: - ::::::::::::::::: ::::::::::::::::::: ::::::: :::: :::::::: :::::::::: ::::::::::::::::::: :: ~.
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From page 174... ...
AMBHA's ( 1995 ~ Performance-Based Measures for Managed Behavioral Healthcare (PERMS 1.0) , perhaps because the AMBHA membership specializes in the management of mental health and substance abuse services, disaggregate penetration and utilization rates by age and diagnostic category but do not assess the overall need for services and whether the services are appropriate for the needs.
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From page 175... ...
Ethnic minorities are overrepresented in the public system and are underrepresented in the private system, and this poses spe' cial considerations as the public system increasingly contracts with managed care organizations. Rates of need for services diner by age, socioeconomic status, and
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From page 176... ...
. It has also been suggested that the merging of alcohol and drug treatment programs may affect access to treatment in that the balance of treatment capacity for primary alcohol abuse treatment compared with that for a drug problem may shift (Weisner, 1992~.
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From page 177... ...
The symptoms of individuals in this group also are often characterized by the presence of chronic medical conditions and often by repeated admissions for alcohol or drug abuse treatment. This group may also enter treatment programs through the criminal justice system through a variety of alcohol- or drugrelated arrests, including arrests for public intoxication.
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From page 178... ...
and the Patient Placement Cri' teria developed by the American Society on Addiction Medicine (CSAT, 1994~. MEASURING ACCESS TO SERVICES WITHIN MANAGED CARE ORGANIZATIONS National data sets and data sources available at the community level can be used to assess the prevalence of substance abuse problems and the services needed within health plans.
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From page 179... ...
The rates of al' cohol and drug abuse problems by age, sex, and socioeconomic status are quite consistent, particularly when they are adjusted by region of the country. SUMMARY Managed behavioral health care organizations define access and accessibility using utilization (e.g., penetration rates and the use of specific services)
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From page 180... ...
REFERENCES AMBHA (American Managed Behavioral Healthcare Association)
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From page 181... ...
1994. Medicaid funding for drug abuse treatment A national perspective.
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From page 182... ...
1992. Private versus public sector insurance coverage for drug abuse.
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From page 183... ...
1992. A comparison of male and female clients in substance abuse treatment.
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