Treatment of major depression before and after implementation of a behavioral health carve-out plan

Objective: The study examined utilization, payments, and quality indicators for treatment of major depressive disorder before and after the 1993 imple mentation of a behavioral health care call e-out plan for Massachusetts sta te employees who received medical coverage through indemnity plans or prefe rred provider organizations, Methods: The sample of 2,259 enrollees with cl aims for treatment of major depressive disorder was dt awn from the group o f 39,541 persons continuously enrolled in preferred provider organizations or indemnity plans for fiscal years 1992 to 1995, A subsample of 243 users of inpatient services accounted for 352 admissions. Bivariate tests were us ed to compare utilization and quality indicators before and after implement ation of the carve-out plan, Simple comparisons of current-year dollars Mer e used, Results: The proportion of enrollees with claims for treatment of m ajor depressive disorder increased significantly under the carve-out plan. Inpatient utilization decreased substantially mostly due to a significantly lower average length of stay (16 days before implementation of the cane-ou t plan and nine days after). Net inpatient payments fell 71 pel cent overal l, 65 percent per admission, and 40 percent pel day. The unadjusted proport ion of discharged patients treated for major depressive disorder who were r eadmitted within 15 and 30 days did not change significantly, The unadjuste d proportion of cases receiving follow-up within those time frames increase d significantly. Conclusions: Implementation of a behavioral health carve-o ut plan may be accompanied by substantial reductions in inpatient utilizati on and payments for treatment of major depressive disorder Descriptive find ings suggest that such reductions may not have a detrimental impact on read mission and follow-up treatment rates within 30 days. However, this analysi s did not control for patient characteristics, used short follow-up periods , and did not include some relevant outcome measures.