Quality measurement and accountability for substance abuse and mental health services in managed care organizations.
OBJECTIVE
To analyze managed care organizations' (MCOs') use of behavioral health quality management activities using nationally representative survey data.


METHODS
The primary data source is the Brandeis Survey on Alcohol, Drug Abuse, and Mental Health Services in MCOs. Using a sampling strategy designed for national estimates, we surveyed 434 MCOs in 60 market areas (response rate = 92%) regarding their commercial products' behavioral health services in 1999. Of these, 417 MCOs reported clinically oriented information for 752 products. We investigated the use of four behavioral health quality management activities: patient satisfaction surveys, clinical outcomes assessment, performance indicators, and practice guidelines. chi tests and logistic regression were used to determine effects of product type (HMO, PPO, point-of-service) and behavioral health contracting arrangement (specialty contract, comprehensive contract including general medical and behavioral health, internal provision).


RESULTS
Three-quarters of products used patient satisfaction surveys (70.1%), performance indicators (72.7%), and practice guidelines (73.8%) for behavioral health. Under half (48.9%) assessed clinical outcomes. HMO products were most likely, and PPOs least likely, to conduct activities. Quality activities were significantly more common among specialty-contract products. Logistic regression showed significant negative effects on quality activity use for PPO and POS products compared with HMOs. For clinical outcomes, specialty- and comprehensive-contract arrangements had significant positive effects. There were interactions between product type and contract arrangement.


CONCLUSIONS
Most commercial managed care products use patient satisfaction surveys, performance indicators, and practice guidelines for behavioral health, whereas clinical outcomes assessment is less common. Product type and contracting arrangements significantly affect use of these activities.
Levy Merrick
Elizabeth
E
Schneider Institute for Health Policy, Heller School for Social Policy and Management, MS 035 Brandeis University, 415 South Street, Waltham, MA 02454-9110, USA. merrick@brandeis.edu
Garnick
Deborah W
DW
Horgan
Constance M
CM
Hodgkin
Dominic
D
D016009:Chi-Square Distribution; D003284:Contract Services; D006801:Humans; D016015:Logistic Models; D008329:Managed Care Programs / Q000592:standards*; D008605:Mental Health Services / Q000592:standards*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D016320:Substance Abuse Treatment Centers / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States