Identification and treatment of mental and substance use conditions: health plans strategies.
BACKGROUND
Mental health and substance use conditions are under-recognized and under-treated. Private health plans may be able to affect the extent of screening and, thus, identification of enrollees who need treatment.


OBJECTIVE
The goals of this study were to determine strategies used by health plans to identify mental health and substance use conditions; and describe the characteristics of health plans associated with use of these strategies.


METHODS
In 2003, we conducted a nationally representative survey of private health plans regarding behavioral health services. A total of 368 health plans (83% response rate) provided information about their managed care products: health maintenance organization (HMO), point-of-service (POS), or preferred provider organization (PPO) products (812 in total).


METHODS
We asked whether plans verify primary care providers' screening for mental health or substance use conditions, screen outside of primary care, and distribute practice guidelines. We characterized each product in terms of "carve-out" to a specialty behavioral health vendor, tax status, and region and market area population.


RESULTS
Thirty-four percent of products verify primary care providers' screening for mental health, but only 8% verify alcohol or drug screening. Outside of primary care, 31% conduct screening through the mail, phone, or internet. Depression guidelines are distributed to primary care providers by 78% of managed care products: alcohol or drug guidelines are distributed by 33%. In multivariate analyses, specialty contracting was positively associated, and PPO product type was negatively associated with these strategies.


CONCLUSIONS
Most health plans use multiple strategies to improve identification of behavioral health conditions, but use of such strategies was greater for mental health than for substance use conditions.
Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02454, USA. garnick@brandeis.edu
Deborah W
DW
Garnick
Constance M
CM
Horgan
Elizabeth L
EL
Merrick
Alex
A
Hoyt
D006801:Humans; D007343:Insurance Carriers; D007348:Insurance, Health; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy*