Health plan requirements for mental health and substance use screening in primary care.
BACKGROUND
Screening for substance abuse and mental health in primary care can improve detection. One way to advance screening is for health plans to require it.


OBJECTIVE
We developed national estimates of the prevalence and type of mental and substance-use condition screening health plans require of primary care practitioners.


METHODS
In 1999 (N = 434, response rate = 92%) and 2003 (N = 368, response rate = 83%), we conducted a nationally representative health plan survey regarding alcohol, drug, and mental health services, including screening requirements.


METHODS
Health plans reported on screening requirements of their top three private insurance products. Products were categorized by type (HMO, POS, or PPO), behavioral health contracting arrangements, tax status, market area population, and region.


METHODS
We asked whether primary care practitioners are required to use a general health screening questionnaire (including mental health, alcohol, or drugs items) and/or a screening questionnaire focused on mental health, alcohol, or drug problems.


RESULTS
By 2003, 34% of products had any behavioral health screening requirements. Although there was no increase from 1999 to 2003 in requirements for any kind of behavioral health screening, requirements for using a standard screening instrument declined for mental health but increased for alcohol and drug screening. PPOs showed the largest increase in prevalence of behavioral health screening requirements. Products contracting with managed behavioral health organizations were more likely to require screening.


CONCLUSIONS
Most products do not require behavioral health screening in primary care. More screening could help to improve identification of behavioral health conditions, a first step towards effective treatment.
Horgan
Constance M
CM
Institute for Behavioral Health, Schneider Institutes, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA. horgan@brandeis.edu
Garnick
Deborah W
DW
Merrick
Elizabeth L
EL
Hoyt
Alex
A
D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000592:standards; D006801:Humans; D007348:Insurance, Health / Q000592:standards*; D008403:Mass Screening / Q000592:standards*; D001523:Mental Disorders / Q000175:diagnosis; D008609:Mental Status Schedule / Q000592:standards*; D017410:Practice Guidelines as Topic; D011243:Preferred Provider Organizations / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D015813:Substance Abuse Detection / Q000379:methods / Q000592:standards*; D019966:Substance-Related Disorders / Q000175:diagnosis; D014481:United States