Benefits in Behavioral Health Carve-Out Plans of Fortune 500 Firms

Merrick, Elizabeth L.; Garnick, Deborah W.; Horgan, Constance M.; Goldin, David; Hodgkin, Dominic; Sciegaj, Mark

doi:10.1176/appi.ps.52.7.943

Cited by 15 publications

(13 citation statements)

References 15 publications

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“…For mental health, these findings corroborate earlier work on cost sharing in employer plans (Salkever, Shinogle, and Goldman 1999;Sturm and McCulloch 1998;Merrick et al 2001). For substance abuse treatment, these results are new, given the lack of prior data.…”

Section: Discussionsupporting

confidence: 82%

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Cost Sharing for Substance Abuse and Mental Health Services in Managed Care Plans

Hodgkin

Horgan²,

Garnick³

et al. 2003

Med Care Res Rev

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Recent initiatives to improve private insurance coverage for substance abuse and mental health in the United States have mostly focused on equalizing coverage limits to those found in general medical care. Federal law does not address cost sharing (copayments and coinsurance), which may also deter needed care or impose significant financial burdens on enrollees. This article reports on cost sharing requirements for outpatient care in a nationally representative sample of managed care plans in 1999. Levels of cost sharing are substantial, with around 40 percent of products requiring copayments of $20 or more and another 15 percent requiring coinsurance of 50 percent. Cost sharing for outpatient substance abuse treatment is very similar to that for mental health. Compared to general medical care, at least 30 percent of products impose higher cost sharing for substance abuse and mental health treatment. Future parity initiatives should be examined for how they address differences in cost sharing as well as limits.

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Section: Discussionsupporting

confidence: 82%

“…Two exceptions are Peele, Lave, and Xu (1999), who report that substance abuse cost sharing was the same as for mental health in all but 1 of 46 plans with a single MBHO, and Merrick et al (2001), who found that cost sharing was the same for 94 percent of large employers who carved out behavioral health.…”

Section: Prior Studiesmentioning

confidence: 99%

Cost Sharing for Substance Abuse and Mental Health Services in Managed Care Plans

Hodgkin

Horgan²,

Garnick³

et al. 2003

Med Care Res Rev

Self Cite

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“…Performance standards to monitor staffing ratios have not been widely adopted by employers in their contracts with carve outs rendering behavioral care. 26 The situation in public sector managed mental health care appears at best to be analogous. A recent nationwide study of Medicaid managed-care contracts reports that states are making efforts to specify standards regarding network structure to promote access to general medical care, but these were found to be missing or very general in the case of specialty care.…”

Section: Implications For Behavioral Health Servicesmentioning

confidence: 99%

Provider turnover in public sector managed mental health care

Albizu-García¹,

Ríos²,

Juarbe

et al. 2004

The Journal of Behavioral Health Services & Research

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The present study examines the extent of turnover in mental health provider networks within public sector managed mental health care over a 1-year period and its association to provider and practice characteristics. Telephone interviews were conducted with a sample of mental health services providers listed the previous year in the networks of the 3 public sector managed mental health care organizations operating in Puerto Rico. Thirty-one percent of respondents had dropped out of networks. The drop-out rate was significantly associated (P < or = .05) with increasing number of years in practice and decreasing years under contract. A nonsignificant trend was observed, suggesting that providers with subspecialty training are less likely to drop out. The results may be signaling an emerging problem in public sector managed mental health care. Stability of provider networks should be monitored by state agencies contracting out mental health care.

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“…For example, of the 336 Fortune 500 companies surveyed by Elizabeth Merrick and colleagues, 39 percent reported firm-level contracts with MBHOs. 13 This study did not examine employees with carved-out benefits at the plan level.…”

Section: Study Findingsmentioning

confidence: 99%