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Special Report
Preventive Interventions
Under Managed Care: Mental Health
and Substance Abuse Services
Introduction
The prevalence and consequences of substance abuse and
mental health problems in the United States create an imperative
not only to develop adequate, appropriate, and effective
treatments, but also to maximize the potential of preventive
approaches. The burden of these problems includes the suffering of the
individual and of those in that person’s environment, the costs of medical
treatment and other related services, and the loss of productivity at
work and at home. The stigma often associated with mental health and
substance abuse problems imposes an additional burden. Many of these
problems are chronic or recurring; are difficult to treat; and require
extensive, expensive services that may not be available or sufficient to
meet community demands. For all of these reasons, prevention and early
identification of mental disorders and substance abuse is vastly preferable
to the human and material costs of related illness, treatment, and
rehabilitation.
Increasing numbers of Americans depend
upon managed care organizations (MCOs)
to meet their health care needs. In this era
of escalating health care costs, purchasers
of health care are under enormous pressure
to obtain the highest quality and most comprehensive
services at the lowest possible
price. Because of their central role in promoting
and protecting the health of millions
of Americans, MCOs have a particularly
strong stake in the substance abuse and
mental health arena and a unique opportunity
to intervene as early as possible to
prevent and control substance abuse and
mental health problems in their enrolled
populations.
Programs and services to prevent substance
abuse and mental health problems
should be available through all MCOs
because they are a vital component of the
health care continuum. When available, documentation
of effectiveness and cost savings
(or cost neutrality) strengthens the case for
incorporating preventive behavioral health
care services into MCO contracts. "Where
there is a perceived financial incentive,"
notes one analyst, "prevention has flourished"
(Omenn, 1994, p. 7).
However, lingering questions about the
effectiveness of preventive interventions and
concern about their impact on cost have
contributed to reluctance among some
MCOs to cover these services. Even if a preventive
intervention has been proven effective,
MCOs may hesitate to provide coverage
if the costs of delivering the service are
not greater than or at least neutralized by
associated savings. For MCOs, interventions that demonstrate short-term savings
in other covered treatment services are of
great interest. Some interventions may produce
payoffs outside the medical care system
(for example, by reducing workplace
absenteeism) or over the long term, when
the savings may not be realized by the
MCO that provided the prevention program
or service. As ongoing research provides
greater insight into the costs of preventive
interventions for substance abuse and mental
health problems, it will be important
to design and test financial incentives to
invest in preventive services for providers
that do not derive short-term economic
benefit from their adoption.
Therefore, this document responds to two
questions commonly asked about these interventions:
(1) Are they effective? (2) Can they
produce cost savings, or can they be provided
without increasing the net cost of care? This
literature review addresses concerns about
the outcomes and cost of these preventive
interventions and helps reduce barriers to
coverage for programs and services proven
to be effective and economically feasible.
The summarized articles provide science-based
evidence that interventions designed
to prevent substance abuse and mental
health problems can contribute to health
and well-being; many also demonstrate
either cost savings or no negative impact
on cost. This evidence may not be widely
known among purchasers and consumers.
Persuasive evidence can help managed
care executives, health care purchasers, and
consumers make informed decisions about
the benefits and liabilities of incorporating
effective interventions in managed care contracts.
The Substance Abuse and Mental
Health Services Administration (SAMHSA)
is responsible for disseminating knowledge
regarding model programs and their out-comes
and for publicizing results of state-of-the-art research and evaluation. It is vital
that managed care stakeholders learn about
research that demonstrates the value of preventive
substance abuse and mental health
services. That is the primary purpose for
which this review has been developed.
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