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With mental health and substance-abuse treatment costs averaging about 10% of a company's annual health bill, companies are looking for new ways to cap expenses. Some firms have decided to give specialists the job of managing the behavioral health portion of their medical benefits programs, according to a new survey of 350 companies by the Wyatt Co.
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President Clinton aims to guarantee coverage not only to the severely disturbed but to all Americans. The cost, however, could be astronomical.
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Mental health and substance abuse disorders are as prevalent among Americans as disorders affecting physical health; therefore, no comprehensive health reform program can be enacted that does not include coverage for mental health services. While some fear the cost consequences, benefit costs of these services have actually grown more slowly than for those of general medicine. Several changes in how mental health services are delivered and financed can ensure access under a reformed health system.
Separating mental health care from other benefits helps keep costs down while improving treatment, experts say.
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State-of-the-art treatment of alcoholism is not the 12-step process developed by Alcoholics Anonymous, not intensive inpatient treatment, and not necessarily aggressive outpatient management. According to the authors, there is even controversy today as to whether alcoholism should be treated as if it is indeed a "disease".
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Medical cost offset was discovered in the health maintenance organization (HMO) setting over 35 years ago and was used not only to justify the earliest instances of the inclusion of mental health treatment as a benefit, but also was used in program design and development. With the new emphasis on outcomes research, medical cost offset remains a viable method of conducting nonintrusive studies of efficacy, efficiency, and quality. Through the use of the research design described, an early HMO delivery system developed 68 focused, target behavioral interventions that years later became the basis for emerging managed mental health care.
Federal and state governments are now rapidly preparing to restructure the delivery and financing of health care services in the United States. Unfortunately, the bureaucratic structures promised under managed competition do not acknowledge the successes of private sector "market-regulated" programs. A needlessly costly and burdensome system could evolve that will undermine the goals of improved access and quality of care.
Computerization of behavioral health care information systems is revolutionizing how payors, managed care companies, and providers exchange information. In this article, an imaginary scenario is depicted of how patient data will be accessed and communicated to facilitate care management of behavioral health care services in the near future.
Massachusetts has harnessed taxpayer dissatisfaction with government to support change. Restructuring has permitted the Department of Mental Health to shift resources from state hospitals to comprehensive community support systems, the foundation for the Department's public managed care initiative. A commitment to psychosocial rehabilitation principles and consumer choice have produced radical change in the delivery and composition of mental health care services. While quality and utilization management programs provide the infrastructure to ensure accountability, quality, and cost effectiveness, education and the building of partnerships support planning and promote progress.