Managed Behavioral Health Care Research Articles

Collaborative Governance in the Age of Managed Behavioral Health Care

AbstractObjective: Collaborative governance engages public and private stakeholders in shared decision-making. In this article, we investigate New York State’s Regional Planning Consortiums (RPCs),...

EAP Service Use in a Managed Behavioral Health Care Organization: From the Employee Perspective

Contemporary Employee Assistance Program (EAP) services are typically provided in broad-brush programs delivered by large external vendors in a network model. Yet research has not kept pace with EAP evolution, including in terms of how EAP clients themselves view services. The authors surveyed a random sample of EAP service users from a national provider (361 respondents). About one third of respondents reported getting help for workplace issues. Most learned about the EAP through employer communications such as the company Web site. The large majority reported that the EAP helped them “a lot” or “some,” suggesting they valued this benefit.

Integrated employee assistance program/managed behavioral health plan utilization by persons with substance use disorders

New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product ( N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes.

Patterns of Service Use in Two Types of Managed Behavioral Health Care Plans

Patterns of Service Use in Two Types of Managed Behavioral Health Care Plans

Patterns of Service Use in Two Types of Managed Behavioral Health Care Plans

The study examined service use patterns by level of care in two managed care plans offered by a national managed behavioral health care organization (MBHO): an employee assistance program (EAP) combined with a standard behavioral health plan (integrated plan) and a standard behavioral health plan. The cross-sectional analysis used 2004 administrative data from the MBHO. Utilization of 11 specific service categories was compared. The weighted sample reflected exact matching on sociodemographic characteristics (unweighted N=710,014; weighted N=286,750). A larger proportion of enrollees in the integrated plan than in the standard plan used outpatient mental health and substance abuse office visits (including EAP visits) (p<.01) and substance abuse intensive outpatient or day treatment (p<.05), and the proportion using residential substance abuse rehabilitation was lower (p<.05). The integrated and standard products had distinct utilization patterns in this large MBHO. In particular, greater use of certain outpatient services was observed in the integrated plan.

Case‐Mix Adjustment of Consumer Reports about Managed Behavioral Health Care and Health Plans

To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent). Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified. The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.

The Challenges of Implementing an Evidence-Based Practice to Meet Consumer and Family Needs in a Managed Behavioral Health Care Environment

SUMMARY This report describes a case study of how a managed behavioral health care organization used a community-centered model of planning to adopt and implement an evidence-based practice (EBP). The case study involved consensus building and decision-making processes to: (1) develop an implementation plan for adapting the EBP model, including a feasibility assessment to identify existing and needed organizational resources; (2) orient and train clinicians and key community stakeholders; (3) pilot test the EBP; (4) establish an ongoing evaluation plan to monitor fidelity to the model and track outcomes; and (5) develop a plan to sustain the practice. Using a community-centered planning process to bring evidence-based interventions into a managed, behavioral health care environment is time intensive but it promotes the critical steps necessary for sustainability of the EBP. The community-centered planning process allowed for systematic input from a wide rage of stakeholders, addressed the potential barriers to implementation, and allowed for the adaptation of the model within the realities of the current system. This approach to organizational change decreased resistance from staff and increased services to families in the organization.

Prospective validation of substance abuse severity measures from administrative data

Background Severity measures for clients in substance abuse treatment programs are becoming increasingly important as funders adopt payment systems linked to agency performance. Recently, two severity measures based on administrative data have been developed. This study validated these measures using prospective data. Methods Subjects were participants in the Drug Abuse Treatment Outcomes Study (adult or adolescent components) or the Substance Abuse and Mental Health Services Administration Medicaid Managed Behavioral Healthcare and Vulnerable Populations project (adult or adolescent chemical dependency components). Severity measures were calculated based on data obtained at entry into substance abuse treatment. The baseline severity measures were included along with age, gender, and race/ethnicity in logistic regression models predicting abstinence at follow-up for alcohol use, marijuana use, cocaine use, or heroin use. Results For adults, the severity measures were highly statistically significant ( p < 0.001) for all models in both data sets, indicating that adults with higher severity were more likely (and much more likely in many cases) to use alcohol, marijuana, cocaine, or heroin at the follow-up interview than were those with lower severity. For adolescents, the severity measure was highly statistically significant ( p < 0.001) for marijuana in both data sets and for alcohol in the Medicaid data set. Conclusions Baseline severity measures were powerful predictors of abstinence at follow-up. These measures, derived from routinely available electronic records, appear to have noteworthy predictive validity. The severity indicators can be used for administrative purposes such as risk-adjustment when examining treatment agency performance.

Schizophrenia, Co-occurring Substance use Disorders and Quality of Care: The Differential Effect of a Managed Behavioral Health Care Carve-out

This study explores the differential effect of a managed behavioral health Carve-Out (CO) on outpatient treatment quality for persons with schizophrenia (SCHZ) alone and co-occurring substance use disorders (SUD) (SCHZ+SUD). We used claims data from a state Medicaid program and employed a retrospective, quasi-experimental design with logit and difference in difference formula regression models. The results show the CO was associated with greater changes in treatment quality for the SCHZ population, compared to the SCHZ+SUD population. Most pronounced across both populations were decrements in receiving the psychosocial treatments for enrollees in the CO arrangement.

Assessment of Medicaid Managed Behavioral Health Care for Persons With Serious Mental Illness

This five-site study compared Medicaid managed behavioral health programs and fee-for-service programs on use and quality of services, satisfaction, and symptoms and functioning of adults with serious mental illness. Adults with serious mental illness in managed care programs (N=958) and fee-for-service programs (N=1,011) in five states were interviewed after the implementation of managed care and six months later. After a multiple regression to standardize the groups for case mix differences, a meta-analysis using a random-effects model was conducted, and bioequivalence methods were used to determine whether differences were significant for clinical or policy purposes. A significantly smaller proportion of the managed care group received inpatient care (5.7 percent compared with 11.5 percent). The managed care group received significantly more hours of primary care (4.9 compared with 4.5 hours) and was significantly less healthy. However, none of these differences exceed the bioequivalence criterion of 5 percent. Managed care and fee for service were "not different but not equivalent" on 20 of 34 dependent variables. Cochrane's Q statistic, which measured intersite consistency, was significant for 20 variables. Managed care and fee-for-service Medicaid programs did not differ on most measures; however, a lack of sufficient power was evident for many measures. Full endorsement of managed care for vulnerable populations will require further research that assumes low penetration rates and intersite variability.

Overview Of Publicly Funded Managed Behavioral Health Care

Using MEDLINE and other Internet sources, the authors perform a systematic review of published literature. A total of 109 articles and reports are identified and reviewed that address the development, implementation, outcomes, and trends related to Managed behavioral health care (MBHC). MBHC remains a work in progress. States have implemented their MBHC programs in a number of ways, making interstate comparisons challenging. While managed behavioral health care can lower costs and increase access, ongoing concerns about MBHC include potential incentives to under-treat those with more severe conditions due to the nature of risk-based contracting, the tendency to focus on acute care, difficulties assuring quality and outcomes consistently across regions, and a potential cost-shift to other public agencies or systems. Success factors for MBHC programs appear to include stakeholder involvement in program and policy development, effective contract development and management, and rate adequacy.

Managed Behavioral Health Services: Perspectives and Practice

Back to table of contents Previous article Next article Book ReviewsFull AccessManaged Behavioral Health Services: Perspectives and PracticeRobert K. Schreter, M.D.Robert K. SchreterSearch for more papers by this author, M.D.Published Online:1 Sep 2004https://doi.org/10.1176/appi.ps.55.9.1075AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The pace of change in managed behavioral health care has been so rapid that, a mere 15 years after this system of care took hold, a book titled Managed Behavioral Health Services: Perspectives and Practice could have been titled "Managed Behavioral Health Care: A Retrospective" or "Managed Behavioral Health Care: A Requiem."The edited volume includes 15 chapters selected, in part, to highlight the positive contributions of managed behavioral health care. The editor, Saul Feldman, is one of the founders of the managed behavioral care movement and industry. He began his career in academics and as director of the community mental health centers program at the National Institute of Mental Health. He went on to start United Behavioral Health, the nation's third largest managed behavioral health organization, responsible for nearly 20 million covered lives. Contributors to this book are prominent members of industry, academia, and consulting. The articles are thoughtful, balanced, based on data to an unusual degree for this type of discussion, and often scholarly.Of particular value to the reader is the choice of topics. Some chapters review areas that have been widely discussed, including effect on clinical practice, law, physical health, public sector, and training. Others deal with topics that have received less attention and are less well understood by many, including clinical risk management, quality management, employers' perspective, and employee assistance programs. A particularly interesting chapter reviews the literature on the impact of managed behavioral health care on spending, quality, and access; how savings are achieved; and the not-well-recognized, confounding economic variables that make it difficult to draw firm conclusions. A third set of chapters on information systems and services research address areas that have yet to achieve their potential for using managed care's vast reach and massive database to contribute to efficient, effective, evidence-based clinical and administrative services.Three perspectives not included in the book are those of practitioner or facility providers, consumers, and employer or government payers who are on the receiving end of the consumer backlash. This omission should come as no surprise. Dr. Feldman is exercising his editor's prerogative and presents viewpoints that best represent his own.Managed care is a profoundly polarizing topic, with managers and chief financial officers on one end and many consumers and providers on the other. This book is recommended reading for all who occupy a position on this continuum—clinicians of all specialties, consumers, employer and government payers, and policy makers. The essays will be particularly enlightening to clinicians, consumers, and managed care critics who are less familiar with managed care's own view of its role and responsibilities and the expectations and motives of the private and public payers who hire managed care organizations and evaluate their performance.The competition for scarce resources between mental health and physical health and between health care and other social claims will not go away. Managed Behavioral Health Services: Perspective and Practice is an important contribution to the understanding of the challenges that confront the designers of our health care system of the future.Dr. Schreter is clinical associate professor at the University of Maryland School of Medicine and medical director at Future Health Corp in Baltimore.edited by Saul Feldman; Springfield, Illinois, Charles C. Thomas Publisher, 2003, 435 pages, $77.95 FiguresReferencesCited byDetailsCited byNone Volume 55Issue 9 September 2004Pages 1075-1075 Metrics PDF download History Published online 1 September 2004 Published in print 1 September 2004

Using Information to Guide Managed Behavioral Health Care

Using Information to Guide Managed Behavioral Health Care

The Dead Are Dancing

Back to table of contents Previous article Next article Book ReviewsFull AccessThe Dead Are DancingTerry A. Kupers, M.D., M.S.P.Terry A. KupersSearch for more papers by this author, M.D., M.S.P.Published Online:1 Dec 2003https://doi.org/10.1176/appi.ps.54.12.1660-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Novels by mental health professionals risk collapsing into case studies in which the literary notion of character is reduced to a character disorder or some other form of psychopathology. William Lloyd Roller is an accomplished clinician and group therapist, as demonstrated in an earlier book about the place of group therapy in managed health care (1). He is also a fine fiction writer and chooses, in The Dead Are Dancing, to present this timely and fascinating exploration of violence and patriotism in the American psyche through the lens of a novelist's artistry.Billy Richcreek grows up in a small Illinois town where war veterans, guns, and patriotism form the core of working-class culture. Billy becomes a crack marksman as a child on his father's backyard shooting range, but after witnessing his father shoot his baby sister in a fit of rage against his mother, his life changes. He wins celebrity as a high school football legend. As the Vietnam War evolves, he has second thoughts about the violence that permeates the Heartland. Eventually his earnest search for personal integrity leads him to stand up to the town elders and gets him ostracized for protesting a war that just about everyone else supports enthusiastically.This totally engaging novel moves quickly through Billy's coming of age amidst extreme domestic violence, his parting of ways with a best friend who goes off to war but soon returns to join Billy as a peace activist, Billy's struggles with the mores of the sexual revolution and his less-than-glamorous sexual initiation, his charismatic leadership of an incipient peace movement, and a fantastic ending that provides fitting literary closure to the irony, humor, and timelessness of this poignantly written and provocative book. Although the reader easily grasps the novel's relevance to current events, this nuanced and layered work of fiction never degenerates into the flat realism of an explicitly cautionary tale.In general, the period of our coming of age is formative in many ways for the remainder of our lives. Those who entered adulthood during the heady 1960s experience recurring moments when they can actually imagine affecting some part of another person's social vision. A post-9/11 resurgence of vengeance, reactive militarism, and threats to constitutional safeguards is cause for concern about the dangers of a deeply embedded inclination toward thoughtless vengeance in the American psyche, and, for those who are not entirely locked into conformity, a cause for renewed activism. The Dead Are Dancing raises questions about conformity and social action. Why did the townspeople who once cheered for Billy Richcreek as he tore through opposing football teams turn against him as soon as he questioned the war? What makes it possible for a Billy Richcreek to rise above the disapproval of his neighbors and lead a struggle for peace? Roller does not provide easy answers, but the way he raises questions makes this book a solid contribution to our thinking about violence and our social sensibility.Dr. Kupers is institute professor in the Graduate School of Psychology at the Wright Institute in Berkeley, California.by William Lloyd Roller; Berkeley, California, Creative Arts Book Company, 2002, $17.95 softcoverReference1. Roller WL: The Promise of Group Therapy: How to Build a Vigorous Training and Organizational Base for Group Therapy in Managed Behavioral Healthcare. San Francisco, Jossey-Bass, 1997Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 54Issue 12 December 2003Pages 1660-a-1661 Metrics PDF download History Published online 1 December 2003 Published in print 1 December 2003

The Nebraska Medicaid Managed Behavioral Health Care Initiative

The Nebraska Medicaid Managed Behavioral Health Care Initiative

The Impact of Evidence-Based Guideline Dissemination for the Assessment and Treatment of Major Depression in a Managed Behavioral Health Care Organization

The Impact of Evidence-Based Guideline Dissemination for the Assessment and Treatment of Major Depression in a Managed Behavioral Health Care Organization

The Influence of Patient Characteristics on Ratings of Managed Behavioral Health Care

The Influence of Patient Characteristics on Ratings of Managed Behavioral Health Care

A model for managed behavioral health care in an academic department of psychiatry.

In response to the effects of the managed care environment on patient flow and care, the department of psychiatry and behavioral sciences of the Johns Hopkins School of Medicine developed and has been managing a capitated behavioral health care program. The program is responsible for providing mental health and substance abuse services for 22,000 members of the TRICARE Uniformed Services Family Health Plan (USFHP), directed by the U.S. Department of Defense. The integration of primary care and behavioral health care is a major feature of the USFHP/TRICARE program. The authors describe the transition from a carve-out for-profit managed care organization to the integrated program managed by the department. During the first two years of the program, access to services increased and use of inpatient services decreased without the need to deny service use. To supplement previous reports of the involvement of academic psychiatry departments in behavioral health care, the authors supply utilization and financial data that may serve as benchmarks for similar efforts by other departments.

Confessions of a managed behavioral health care physician.

The author describes his early association with several pediatric practitioners in Rhode Island in the 1950s who were among the first to use stimulant drugs in the treatment of children with attentional problems. He also discusses some of the later applications of their work. Since the early 1970s there has been a great deal of public interest in and apprehension about the use of these medications in school children. Since the early 1990s there has been concern about the influence of mental health service delivery systems on the prescriptive practices of physicians. Carved-out behavioral health care systems have the potential to improve the standard of care in the pediatric populations they serve.

State Mental Health Policy: Critical Elements of Public-Sector Managed Behavioral Health Programs for Severe Mental Illness in Five States

he term “managed care” may beused to describe a wide variety ofarrangements that have differentstructures, functions, and effects onthe care of people who have behav-ioral health disorders. The evaluationof public-sector managed care planshas been hindered by a lack of a sys-tematic vocabulary for describingthem and a lack of instruments to op-erationalize this vocabulary into a setof measurement procedures.We developed and pilot tested aninstrument to be used in categorizingpublic-sector managed care arrange-ments (1). The instrument was usedto collect descriptive data on man-aged care plans in the Managed Be-havioral Health Care in the PublicSector Study conducted by the Sub-stance Abuse and Mental Health Ser-vices Administration (SAMHSA). Inthis multisite study, a competitiveprocess was used to fund 21 sites inorder to evaluate managed behavioralhealth services for four target popula-tions. Here we report preliminary de-scriptive data from five SAMHSAsites at which the impact of managedcare on adults with severe mental ill-ness—one of the most vulnerable andimportant public-sector target popu-lations—was studied.