SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Economic and social forces combined with imprecise treatment standards are creating a virtual explosion in employer costs attributable to mental and chemical dependency disorders. To develop appropriate programs for managing these costs, the forces that drive utilization must be understood.
Explore the source record for details and available documents.
While the incidence of mental health and substance abuse problems in our society is dramatically high, perhaps even more shocking is the low percentage of those who receive treatment. And though there has been much debate over the cost of providing mental health coverage, attention must be given to the burdens created by not providing necessary care.
This paper describes the organizational characteristics, benefit coverage, referral pathways, utilization rates, and costs of substance abuse services within 17 HMOs belonging to The HMO Group in 1990. All 17 health plans responded to the questionnaire. Responses to the survey reflected the complexity of HMO substance abuse services. Overall, The HMO Group members provided substance abuse service coverage partly dependent upon state mandates, employer group priorities, and local competitive benefit structures. The HMOs reported that service utilization rates and the productivity of their substance abuse providers were critical information needs currently not fully reported. Overall, the survey responses reflected the need for improvement of clinical information systems and expansion of the aggregate substance abuse database.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The American Managed Behavioral Healthcare Association (AMBHA), is comprised of 15 of the country's leading managed behavioral healthcare companies. In January of 1994, AMBHA issued the following statement of "Principles of Healthcare Reform," as well as proposing an alternative basic benefit package for mental illness and substance abuse coverage under managed care. These documents represent an important effort in defining and describing appropriate behavioral healthcare coverage within the larger national debate on healthcare reform. Please also see the report on the cost impact of managed behavioral healthcare, prepared by AMBHA's Actuarial Subcommittee, on page 18 of this issue of Behavioral Healthcare Tomorrow.
In healthcare reform the evolution toward capitated payment systems raises many questions that are unique to behavioral healthcare providers. These issues include how to structure risk contracts, how to set appropriate prices and how to price and cover the severely mentally ill and uninsured. Two possible solutions to the pricing dilemma are described in this article: using prior-use experience for setting prices, with a DRG-type classification formula, and using a combination of past-use formulas and current utilization data.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Most employer-sponsored health insurance plans provide some coverage for mental health and addiction treatment. However, analysis of over 3,000 employer benefit plans reveals wide variation in the level and scope of behavioral health benefits. Of all commercially insured employees and dependents, 77 percent are currently enrolled in health maintenance organizations (HMOs), preferred provider organizations (PPOs), or point-of-service (POS) managed care plans. This article documents the differences among behavioral health coverage packages in these three different types of managed care organizations (MCOs), and the lower levels of behavioral health coverage compared with coverage for other medical care. The author states that some employers are selecting single-specialty managed behavioral carve-out plans specifically to increase benefit levels and improve quality of care.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.