Mental health carve-outs: Effects and implications

To control the rise in expenditures and to increase access to mental health and substance abuse (MH/SA) services, a growing number of employers and st ates are implementing a "carve-out." Under this arrangement, the sponsor se parates insurance benefits by disease or condition, service category, or po pulation and contracts separately for the management of care and/or associa ted risks. A carve-out allows a unique set of managed care techniques to be applied to a subset of particularly costly or complex benefits. This artic le describes various carve-out models, discusses the potential advantages a nd disadvantages of a full carve-out, and summarizes recent public and priv ate sector research regarding the strategy's effects on access and use, cos t savings and shifting, and quality of care. If concludes by discussing app roaches to the assessment and monitoring of the processes and outcomes asso ciated with a MH/SA carve-out.