How does risk sharing between employers and a managed behavioral health organization affect mental health care?
OBJECTIVE
To study the ways in which allocating the risk for behavioral health care expenses between employers and a managed behavioral health organization affects costs and the use of services.


METHODS
Claims from 87 plans that cover mental health and substance abuse services covering over one million member years in 1996/1997.


METHODS
Multi-part regression models for health care cost are used. Dependent variables are health care costs decomposed into access to any care, costs per user, any inpatient use, costs per outpatient user, and costs per inpatient user. The study compares full-risk plans, in which the managed care organization provides managed care services and acts as the insurer by assuming the risk for claims costs, with contracts in which the managed care organization only manages care (for a fixed administrative fee) and the employer retains the risk for claims.


RESULTS
Full-risk plans are not statistically significantly different from non-risk plans in terms of any mental health specialty use or hospitalization rates, but costs per user are significantly lower, in particular for inpatients.


CONCLUSIONS
Risk contracts do not affect initial access to mental health specialty care or hospitalization rates, but patients in risk contracts have lower costs, either because of lower intensity of care or because they are treated by less expensive providers.
Sturm
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D003284:Contract Services / Q000191:economics; D017281:Cost of Illness; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006302:Health Services Research / Q000458:organization & administration; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000534:rehabilitation; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive; D020414:Risk Sharing, Financial; D019966:Substance-Related Disorders / Q000534:rehabilitation; D014481:United States