MANAGED CARE ORGANIZATIONS AND DRUG TREATMENT

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DESCRIPTION: (Applicant's Abstract) Behavioral Health Managed Care Organizations (BHMCOs) play a key role in managed care in drug abuse services. These units have the responsibility, and authority, to monitor and authorize payment for the provision of care. However, little is known about these units. The current proposal aims to: 1) describe the range and organization of a random sample of BHMCOs; 2) describe the variation in rules and procedures, or "managed care mechanisms," BHMCOs impose on providers; 3) determine the impact of the managed care mechanisms on the services of a random sample of providers; 4) determine the impact of BHMCO internal and environmental characteristics on the managed care mechanisms; and S) to therefore determine the impact of BHMCO internal and environmental characteristics on the services delivered by drug abuse providers. This study builds on The Drug Abuse Treatment System survey, a rigorous longitudinal random sample of outpatient drug abuse treatment providers. It will use the survey to obtain random samples of providers who have managed care contracts (n=180) and BHMCOs that administer each such contract (n-4~). It will build upon previous analyses to develop reliable measures of such factors as: managed care mechanisms, including financial risk mechanisms, bureaucratic mechanisms, and treatment content mechanisms; BHMCO internal and environmental characteristics, such as auspices, age, the degree of competition, and external regulations. The research will measure provider behaviors that affect outcomes: treatment duration, rates of service provision, and access to further care. It will measure costs and benefits of managed care administration. Beyond providing unprecedented descriptions of BHMCO and managed care arrangements in general, the statistical analyses will use multivariate regressions, random regression models, and sample selection models to: 1) predict the nature of managed care mechanisms by BHMCO internal and environmental arrangements; and 2) determine the impact of BHMCO arrangements on provider outcomes, benefits, and costs.