A "facilitated" model of inpatient psychiatric care.
The authors describe a model for an effective partnership between a large health maintenance organization and a fee-for-service acute inpatient psychiatric unit. They present data from five years of experience with the model on a unit serving a catchment area of one million plan members. The model, which is based on "facilitated" care rather than managed care, emphasizes crisis intervention and a strong medical orientation. The HMO contracted with seven psychiatrists to provide treatment and helped develop a value system shared by the physicians and hospital staff. A clinician represented the HMO on the unit and played a key decision-making role in patient care. A total of 4,945 patients were admitted over five years. Costs per admission were reduced 47 percent during this period; the readmission rate was 16.9 percent. Implementation of the model resulted in the delivery of high-quality cost-effective care.
Olden
K W
KW
Department of Psychiatry, Sequoia Hospital, Whipple, California.
Johnson
M P
MP
D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008875:Middle Aged; D010348:Patient Care Team / Q000191:economics*; D017060:Patient Satisfaction; D010554:Personality Disorders / Q000191:economics / Q000628:therapy; D011445:Prospective Payment System / Q000191:economics*; D011567:Psychiatric Department, Hospital / Q000191:economics; D012637:Security Measures / Q000191:economics