More evidence for the insurability of managed behavioral health care

Health Affairs

Volumn 18, Issue 5, 1999, Pages 172-181

  Goldman, William ^a   McCulloch, Joyce ^b   Cuffcl, Brian ^b   Kozma, Danah ^b  

^a United Behavioral Health   (United States)

^b UBH ^*

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; BEHAVIOR THERAPY; COST BENEFIT ANALYSIS; ECONOMICS; FORECASTING; HEALTH INSURANCE; HUMAN; INSURANCE; UNITED STATES;

BEHAVIOR THERAPY; COST-BENEFIT ANALYSIS; FORECASTING; HEALTH BENEFIT PLANS, EMPLOYEE; HUMANS; INSURANCE BENEFITS; MANAGED CARE PROGRAMS; UNITED STATES;

EID: 0342648752     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.5.172     Document Type: Article

References (20)

1. R. Sturm, "How Expensive Is Unlimited Mental Health Coverage under Managed Care?" Journal of the American Medical Association 278, no. 18 (1997): 1533-1537.
2. W. Goldman, J. McCulloch, and R. Sturm, "Costs and Use of Mental Health Services before and after Managed Care" (Pacific Bell Study), Health Affairs (March/April 1998): 40-52; and R. Sturm et al., "Mental Health and Substance Abuse Parity: A Case Study of Ohio's State Employee Program," Journal of Mental Health Policy and Economics 1, no. 1 (1998): 129-134.
3. W. Goldman, J. McCulloch, and R. Sturm, "Costs and Use of Mental Health Services before and after Managed Care" (Pacific Bell Study), Health Affairs (March/April 1998): 40-52; and R. Sturm et al., "Mental Health and Substance Abuse Parity: A Case Study of Ohio's State Employee Program," Journal of Mental Health Policy and Economics 1, no. 1 (1998): 129-134.
4. R. Frank et al., "Some Economics of Mental Health 'Carve-Outs'," Archives of General Psychiatry (October 1996): 933-937; R. Frank et al., "The Economics of Behavioral Health Carve-Outs," New Directions for Mental Health Services (Summer 1998): 41-47; and R. Frank et al., "The Economic Functions of Carve Outs in Managed Care," American Journal of Managed Care, Supplement 4 (25 June 1998): 31-39.
5. R. Frank et al., "Some Economics of Mental Health 'Carve-Outs'," Archives of General Psychiatry (October 1996): 933-937; R. Frank et al., "The Economics of Behavioral Health Carve-Outs," New Directions for Mental Health Services (Summer 1998): 41-47; and R. Frank et al., "The Economic Functions of Carve Outs in Managed Care," American Journal of Managed Care, Supplement 4 (25 June 1998): 31-39.
6. R. Frank et al., "Some Economics of Mental Health 'Carve-Outs'," Archives of General Psychiatry (October 1996): 933-937; R. Frank et al., "The Economics of Behavioral Health Carve-Outs," New Directions for Mental Health Services (Summer 1998): 41-47; and R. Frank et al., "The Economic Functions of Carve Outs in Managed Care," American Journal of Managed Care, Supplement 4 (25 June 1998): 31-39.
7. C.A. Ma and T.G. McGuire, "Costs and Incentives in a Mental Health Carve-Out," Health Affairs (March/April 1998): 53-69; H. Huskamp, "How a Managed Behavioral Health Care Carve-Out Plan Affected Spending for Episodes of Treatment," Psychiatric Services (December 1998): 1559-1562; and E. Merrick, "Treatment of Major Depression before and after Implementation of a Behavioral Health Carve-Out Plan," Psychiatric Services (December 1998): 1563-1567.
8. C.A. Ma and T.G. McGuire, "Costs and Incentives in a Mental Health Carve-Out," Health Affairs (March/April 1998): 53-69; H. Huskamp, "How a Managed Behavioral Health Care Carve-Out Plan Affected Spending for Episodes of Treatment," Psychiatric Services (December 1998): 1559-1562; and E. Merrick, "Treatment of Major Depression before and after Implementation of a Behavioral Health Carve-Out Plan," Psychiatric Services (December 1998): 1563-1567.
9. C.A. Ma and T.G. McGuire, "Costs and Incentives in a Mental Health Carve-Out," Health Affairs (March/April 1998): 53-69; H. Huskamp, "How a Managed Behavioral Health Care Carve-Out Plan Affected Spending for Episodes of Treatment," Psychiatric Services (December 1998): 1559-1562; and E. Merrick, "Treatment of Major Depression before and after Implementation of a Behavioral Health Carve-Out Plan," Psychiatric Services (December 1998): 1563-1567.
10. "Congressional Budget Office Estimates," New York Times, 14 May 1996, A12.
11. Pre-carve-out benefit plans for outpatient mental health treatment offered coinsurance rates of 50-80 percent of usual and customary fees with a fixed reimbursement ceiling for each visit ($20-$80 per visit) and annual limits defined by either the number of outpatient sessions or dollar limits ($1,500-$7,000).
12. However, effective January 1998 P.L 104-204 removed annual and lifetime discriminatory dollar caps.
13. To get care, the member calls a dedicated, around-the-clock, toll-free telephone line staffed by master's-level mental health professionals. The intake counselor screens for risk factors; explains the benefits available; makes referrals to appropriate, convenient network providers; and authorizes the initial increment of services - typically ten sessions of outpatient care. If additional or more intensive care is required, a care manager (a licensed clinician) reviews the patient's clinical status and authorizes additional care as needed. Treatment incurred outside the UBH network does not require care management, with the exception of inpatient care. All claims are processed by UBH, so even if UBH does not manage the care, the claims data are available.
14. R. Littelletal.,SAS System for Mixed Models (Cary,N.C.: SAS Institute Inc., 1996).
15. E. Weissman et al., "The Cost of Access to Mental Health Services in Managed Care" (Unpublished manuscript, NIMH, Bethesda, Md., 1999).
16. B. Cuffel et al., "Does Managing Health Care Services Increase the Cost of Providing Medical Care?" Journal of Behavioral Health Services and Research (forthcoming).
17. D. Lansky, "Measuring What Matters to the Public," Health Affairs (July/August 1998): 40-41.
18. R. Sturm, "Cost and Quality Trends under Managed Care: Is There a Learning Curve in Behavioral Health Carve-Out Plans?" Journal of Health Economics (forthcoming).
19. See, for example, D. Kozma, "1998 Standard Member Satisfaction Survey," UBH Internal Report (San Francisco: UBH, 1999).
20. The data presented in this study were not adjusted for inflation; if they had been, the findings would be even stronger.