Private Health Plans’ Contracts with Managed Behavioral Healthcare Organizations
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Historically, managed behavioral health organizations (MBHOs) have played a large role in arranging the delivery of specialty behavioral health services. Contracts between health plans and MBHOs are important vehicles to influence enrollees’ access to behavioral healthcare and the quality of treatment they receive.1Through a range of methods—performance standards, communication about their expectations, and financial penalties—health plans signal to MBHOs which activities are most important and exert leverage on MBHOs’ behavior. Contractual terms are one way to focus MBHOs’ attention on the quality of behavioral health services. Both health plans and MBHOs understand that quality of services can influence their financial situations, as payors (e.g., employers) that value delivery of quality care to their employees explore incentive-based payment schemes and there is increased scrutiny related to public reporting of performance measures. The impetus for specific contract...
KeywordsHealth Plan Behavioral Health Market Area Behavioral Health Service General Medical Service
This study was funded by the National Institute on Drug Abuse (grant R01 DA 029316) and the National Institute on Alcohol Abuse and Alcoholism (grant R01 AA 010869), National Institutes of Health, Bethesda, MD. The authors thank the respondents from the participating health plans for their time; Patricia Nemeth, Frank Potter, and the staff at Mathematica Policy Research, Princeton, NJ, for fielding the survey; Galina Zolotusky for programming assistance; and Grant Ritter for statistical consultation.
Conflict of Interest
The authors declare that they have no competing interests.
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