CHARACTERISTICS OF PRIVATE-SECTOR MANAGED CARE FOR MENTAL-HEALTH AND SUBSTANCE-ABUSE TREATMENT

Objective: This study examined diversity during the late 1980s in mana ged care programs for mental health, alcohol abuse, and drug abuse to identify ways in which research can generate more meaningful data on t he effectiveness of utilization review programs. Methods: Telephone in terviews were conducted with representatives of utilization review pro grams for employee health insurance plans in 31 firms that employed 2. 1 million people in 1990. Questions addressed qualifications of person nel, clinical criteria to authorize care, integration with employee as sistance plans, penalties for not complying with utilization review pr ocedures, outpatient review, and carve oat of mental health and substa nce abuse review. Results: Large variations in utilization review prog rams were found. Programs employed a range of review personnel and use d a variety of clinical criteria to authorize care. More than two-thir ds did not carve out mental health and substance abase review from med ical-surgical review. Some firms' employee assistance plans were integ rated with utilization review programs, while others remained unintegr ated. Penalties for not following program procedures varied widely, as did review of outpatient services. Conclusions: Because of trends tow ard even more diversity in utilization review programs in the 1990s, r esearch that identifies the specific features of managed care programs that hold most promise for controlling costs while maintaining qualit y of care will increasingly be needed.