Management of behavioral health provider networks in private health plans.
We explored the techniques used by private health plans or by their contracted managed behavioral healthcare organizations (MBHOs) to maintain networks of behavioral health providers. In particular, we focused on differences by health plans' product types (health maintenance organization, point-of-service plan, or preferred provider organization) and contracting arrangements (MBHO contracts, comprehensive contracts, or no contracts). More than 94% of products selected providers using credentialing standards, particular specialists, or geographic coverage. To retain providers viewed as high quality, 54% offer reduced administrative burden and 44% higher fees. Only 16% reported steerage to a core group of highest-quality providers and few reported an annual bonus or guaranteed volume of referrals. Some standard activities are common, but some health plans are adopting other approaches to retain higher-quality providers.
Garnick
Deborah W
DW
Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Mass., USA. garnick@brandeis.edu
Horgan
Constance M
CM
Reif
Sharon
S
Merrick
Elizabeth L
EL
Hodgkin
Dominic
D
D001524:Behavioral Medicine / Q000458:organization & administration* / Q000592:standards; D002391:Catchment Area, Health; D003284:Contract Services / Q000592:standards; D003406:Credentialing; D019538:Health Care Surveys; D006279:Health Maintenance Organizations; D006801:Humans; D008329:Managed Care Programs / Q000145:classification / Q000458:organization & administration* / Q000592:standards; D008605:Mental Health Services / Q000145:classification / Q000458:organization & administration* / Q000592:standards; D020403:Patient Freedom of Choice Laws; D011243:Preferred Provider Organizations; D011331:Private Practice / Q000592:standards*; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*; D017749:Total Quality Management; D014481:United States