BHMCOBehavioral Health Managed Care Organization
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Behavioral Health Managed Care Organizations (BHMCOs) generally control the separated benefits.
Few BHMCOs capitate providers (providing them with a set fee per enrollee).
The analyses use a unique data set, which involves a random sample of formal contracts between BHMCOs on the one hand, and outpatient drug treatment agency providers, on the other.
The data set summarizes reports front agency provider representatives concerning the nature of up to three of their contracts with BHMCOs (repeating the same questions).
The providers' directors were asked to list the BHMCOs with which they had contracts.
For example, they cover mandates that providers ask the permission of BHMCOs to treat each client, allow BHMCOs to conduct reviews on the basis of written records, cede to written standards that dictate which clients are eligible for services (for example, clients with previous treatment episodes may be allowed more sessions), or submit data on case outcomes.
As Table 1 suggests, these dichotomous variables measure whether BHMCOs stop payments when care standards are not met in a contract (62 percent reportedly thus stop payments), disallow claims (73 percent), or reimburse providers for less than the cost of care (77 percent).
The dimension's high-loading items involve mandates for providers to seek oral permission from BHMCOs before providing care at two review stages.
Statistically significant results involving financial mechanisms suggest that the proportion of cases receiving at least 10 treatment sessions under a contract is lower when BHMCOs stop payments and thus place on providers the financial risks associated with longer stays.
Other statistically significant coefficients suggest that the proportion of clients receiving at least 20 treatment sessions under a contract is lower when BHMCOs either stop payments or reimburse providers for less than costs.
Another relation suggests that the proportion of cases completing treatment is higher when BHMCOs stop payments.
But if it is assumed that outcomes are superior when providers have the autonomy to fully match clients to treatment, and that MCOs are not that capable by themselves, the lack of a relation may suggest that centralization spurs a high level of communication between providers and BHMCOs, which allows providers to supply information to, or negotiate with, MCOs.