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Management of behavioral health provider networks in private health plans.

Authors
  • Garnick, Deborah W
  • Horgan, Constance M
  • Reif, Sharon
  • Merrick, Elizabeth L
  • Hodgkin, Dominic
Type
Published Article
Journal
The Journal of ambulatory care management
Publication Date
Jan 01, 2008
Volume
31
Issue
4
Pages
330–341
Identifiers
DOI: 10.1097/01.JAC.0000336552.62084.3b
PMID: 18806593
Source
Medline
License
Unknown

Abstract

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.

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