Major Dimensions of Manged Behavioral Health Care Arrangements

Major Dimensions of Managed Behavioral Health Care Arrangements

Co-investigators: M. Susan Ridgely, M.S.W. and J.D., David Shern, Ph.D. Florida Mental Health Institute, Judith Samuels, Ph.D., Carole Siegel, Ph.D.

PROJECT GOALS

Managed care plans vary widely in terms of how they operate and in their organizational, financial and clinical structures. The goal of this project is to develop a taxonomic survey instrument to describe managed care plans, in order to facilitate comparative studies. Such instrument would be useful in characterizing those components of a managed care plan that can be hypothesized to have some influence on client outcomes.

RESEARCH ACTIVITIES AND RESULTS

A Managed Care Advisory Panel representing national mental health organizations, university academic centers, state health and mental health agencies, MCO's and investigators from the SAMHSA project on managed care for vulnerable populations was formed to deliberate on the dimensions to be described. The panel defined a classification system to describe different levels of the independent variable (managed care) that are most likely to affect the dependent variable (client outcome). Four critical domains that would capture the majority of variables among MCO's were identified and defined: benefit design, risk, accountability and covered population. Subsequent work entailed creating for each domain the actual questions and response sets to be included in the survey instrument. The prior work of a number of investigators helped influence the design of the questions to be used. In deciding whether to include a particular question, two decision rules were applied: (1) Will the proposed question discriminate between fee-for-service and managed care plans, or among managed care plans?; (2) If not, is it an important public policy concern that warrants its inclusion anyway?

The survey designed captures a variety of dimensions at three levels:

purchaser to managed care organization (MCO);
MCO to behavioral health organization (BHO); and
BHO to service provider network.

The unit of analysis for Level 1 is a managed care arrangement between a purchaser or group of purchasers and a MCO or set of MCO's. At Level 2, the unit of analysis is a contract between the MCO and BHO(s), where a MCO is contracting with one or more BHO's. At Level 3, the instrument analyzes contracts between the MCO/BHO and the service providers in their network (both individual practitioners and institutional providers). Survey informants are the parties to the contract and other relevant parties, e.g., state administrative authorities. Data may be collected through interviews, completion of forms, and reviews of the contract and other documents.

The overall instrument designed is not a pen and paper survey. Many of the questions asked are complex and require data from a variety of sources. The instrument was written for data collection by trained interviewers with knowledge of managed behavioral health care and administrative services and systems.

In collaboration with the Human Services Research Institute, the instrument was revised and used in the SAMHSA funded cross site study of 21 different models of behavioral health care. Draft administration manuals were developed.

SIGNIFICANCE OF FINDINGS/POLICY IMPLICATIONS

One of the basic theories of managed care is that if clinical and financial incentives are aligned, a system will emerge that provides better care at a lower price. This instrument attempts to specify those clinical and financial incentives in a way that will allow meaningful cross-plan and cross-state comparisons.

PLANS

Work continues on the risk sharing arrangement section.

Updated: 3/18/99

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