Costs And Incentives In A Behavioral Health Carve-Out

Albert, Ching‐to; McGuire, Thomas G.

doi:10.1377/hlthaff.17.2.53

Cited by 148 publications

(80 citation statements)

References 5 publications

(3 reference statements)

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“…19 A similar analysis of the MBHC plan in Massachusetts between 1991 and 1995 found a 30-40 percent decline in costs. 20 These reductions have sharply reduced aggregate behavioral health care spending in recent years. In a 1999 study of 1,043 employers, the Hay Group found that spending for behavioral health care in the private sector was 3.2 percent of all health care costs in 1998, down from 6.1 percent in 1988.…”

Section: The Future Of the Industrymentioning

confidence: 99%

Managed Behavioral Health Care In 1999: An Industry At A Crossroads

Findlay¹

1999

Health Affairs

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Section: The Future Of the Industrymentioning

confidence: 99%

Managed Behavioral Health Care In 1999: An Industry At A Crossroads

Findlay¹

1999

Health Affairs

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“…These studies examine benefit expansions in response to parity regulation, as well as employer initiated and health plan initiated benefit expansions. For example, when the health insurance program for Massachusetts state employees introduced a managed care carve-out at the same time mental health benefits were expanded, the net effect was a 25 percent decline in spending (Ma & McGuire, 1998). Most savings result from decreases in use and spending for inpatient care.…”

Section: Introductionmentioning

confidence: 99%

Mental health and substance abuse insurance parity for federal employees: How did health plans respond?

Barry

Ridgely

2007

J Policy Anal Manage

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“…10 This view is based on the observation that carve-outs that include significant risk sharing with the vendor perform similarly to those with only a small amount of risk sharing. Evidence from this natural experiment, in which a mature MBHO began using risk-sharing contracts with selected providers, supports an alternative view.…”

Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Risk Sharing In Managed Behavioral Health Care

Rosenthal¹

1999

Health Affairs

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Mental health visits went down 25 percent when a large behavioral health care firm changed the way it contracts with providers.by Meredith B. Rosenthal ABSTRACT: While policymakers have expressed concern over the impact of risk sharing with providers on treatment patterns, the literature lacks decisive evidence on which to base policy. This paper evaluates the impact of a contracting change within a managed behavioral health organization from a fee-for-service system to a case-rate system with utilization management delegated to providers. The contracting change resulted in a 25 percent reduction in mental health visits per episode. This effect varies with the dollar amount of the case rate and is more pronounced for providers with a larger share of revenue from risk contracts and with intensive utilization management programs.W id e sp re ad cha ng es in t h e w a ys in which managed care organizations contract with providers have led to concerns about the impact of provider risk bearing on treatment choices. In particular, the locus of clinical management and financial responsibility has shifted away from health plans toward provider organizations.In behavioral health the transfer to providers of financial risk and the accompanying responsibility for managing care is still emerging. Recent evaluations of carve-outs to managed behavioral health organizations (MBHOs) indicate the reliance of these entities on more traditional cost-control methods such as preauthorization and closed networks.1 However, some risk sharing with behavioral health care providers is beginning to occur. For example, in 1997, 14 percent of psychiatrists participated in capitation contracts.2 The proliferation of new behavioral health care organizations analogous to physician practice management (PPM) companies may be further evidence that risk sharing in behavioral health is on the rise. Through a variety of organizational forms, psychiatric PPMs (PPPMs) provide the necessary scale and skills that behavioral health care providers need to accept delegated contracts. Although most public and private payers have remained skeptical about downstream contracting between MBHOs and providers,

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Costs And Incentives In A Behavioral Health Carve-Out

Cited by 148 publications

References 5 publications

Managed Behavioral Health Care In 1999: An Industry At A Crossroads

Managed Behavioral Health Care In 1999: An Industry At A Crossroads

Mental health and substance abuse insurance parity for federal employees: How did health plans respond?

Risk Sharing In Managed Behavioral Health Care

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