Risk sharing in managed behavioral health care

Health Affairs

Volumn 18, Issue 5, 1999, Pages 204-213

  Rosenthal, Meredith B ^a  

^a HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; BEHAVIOR THERAPY; COST BENEFIT ANALYSIS; ECONOMICS; FEMALE; FINANCIAL MANAGEMENT; HEALTH INSURANCE; HUMAN; MALE; MIDDLE AGED; RISK MANAGEMENT; UNITED STATES;

ADULT; BEHAVIOR THERAPY; CONTRACT SERVICES; COST-BENEFIT ANALYSIS; FEMALE; HUMANS; MALE; MANAGED CARE PROGRAMS; MIDDLE AGED; RISK SHARING, FINANCIAL; UNITED STATES;

EID: 0033192603     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.5.204     Document Type: Article

References (14)

1. C.A. Ma and T.G. McGuire, "Costs and Incentives in a Behavioral Health Carve-Out," Health Affairs (March/April 1998): 53-69; and W. Goldman, J. McCulloch, and R. Sturm, "Costs and Use of Mental Health Services before and after Managed Care," Health Affairs (March/April 1998): 40-52.
2. C.A. Ma and T.G. McGuire, "Costs and Incentives in a Behavioral Health Carve-Out," Health Affairs (March/April 1998): 53-69; and W. Goldman, J. McCulloch, and R. Sturm, "Costs and Use of Mental Health Services before and after Managed Care," Health Affairs (March/April 1998): 40-52.
3. Physician Marketplace Statistics, 1997/1998 (Chicago: American Medical Association, 1998).
4. M. Rosenthal et al., "Psychiatric Provider Practice Management Companies: Adding Value to Behavioral Health?" Psychiatric Services (5 August 1999): 1011-1013.
5. There are notable exceptions to this general statement. For example, the Massachusetts Division of Medical Assistance has prohibited its behavioral health carve-out vendor from sharing risk with providers.
6. These measures may be endogenously determined with treatment choices, as they are potential substitutes for outpatient care. However, excluding these variables does not significantly change the estimates of the effect of the case rate on outpatient treatment.
7. This episode definition has been validated and widely used in the literature. See L. Kessler, "Episodes of Psychiatric Utilization," Medical Care (December 1980): 1219-1227. Sensitivity analysis using six weeks and twelve weeks to define episodes was performed with no qualitative change in the results.
8. For complete details regarding the estimation, a technical appendix is available upon request from the author at mrosenth@hsph.harvard.edu.
9. Patients are unlikely to be actively selecting certain types of providers here, since their costs do not differ across the two types of providers and they are unlikely to be aware of the method of payment.
10. A number of studies have found the Global Assessment of Functioning a reliable and valid indicator of psychological disturbance. See D. Patterson and M. Lee, "Field Trial of the Global Assessment of Functioning Scale - Modified," Amcricanjoumal of Psychiatry (September 1995): 1386-1388.
11. Ma and McGuire, "Costs and Incentives in a Behavioral Health Carve-Out;" and Goldman et al., "Costs and Use of Mental Health Services."
12. Ma and McGuire, "Costs and Incentives in a Behavioral Health Carve-Out;" and Goldman et al., "Costs and Use of Mental Health Services."
13. C.S. Austad, "Can Psychotherapy Be Conducted Effectively in Managed Care Settings?" in Controversies in Managed Mental Health Care, ed. A. Lazarus (Washington: American Psychiatric Press, 1996); and I.J. Miller, "Time-Limited Brief Therapy Has Gone Too Far: The Result Is Invisible Rationing," Professional Psychology - Research and Practice (December 1996): 567-576.
14. C.S. Austad, "Can Psychotherapy Be Conducted Effectively in Managed Care Settings?" in Controversies in Managed Mental Health Care, ed. A. Lazarus (Washington: American Psychiatric Press, 1996); and I.J. Miller, "Time-Limited Brief Therapy Has Gone Too Far: The Result Is Invisible Rationing," Professional Psychology - Research and Practice (December 1996): 567-576.