NETWORK EFFECTS IN MENTAL HEALTH MANAGED CARE

引入管理式医疗后，心理健康成本节省30%的情况并不少见。提供商对管理型医疗服务的回应是，在利用率审查或供应方价格激励无法解释的方式上做得更少。看来，被纳入管理型医疗服务的机会是一个强大的激励因素。我们将“网络”定义为市场中以优惠条件向管理型医疗计划(计划)出售服务的提供者的子集。作为交换，该计划将业务导向网络中的提供商。我们建议使用国家一级医院服务市场内三轮网络创建的数据来研究网络对提供给患者的护理质量的影响。我们还将研究网络设计问题。我们将开发和测试一种“最优网络”理论，该理论在讨价还价能力和信息给付款人带来的收益与消费者在选择上的损失之间取得平衡。马萨诸塞州的精神健康和药物滥用医院护理市场是研究网络效应的绝佳网站。医院已经经历了与创业计划相关的三轮网络形成，两次是在医疗补助计划中，一次是在该州最大的私人雇主团体保险委员会。此外，医院经历了卫生保健组织的增长，他们使用医院网络来照顾他们的参保人。因此，这种设置提供了一个机会来测试网络创建对患者护理、健康计划成本和提供商行业的影响，并研究“最佳”网络的设计问题。该提案有四个具体目标：1)描述与引入三轮网络相关的马萨诸塞州医院层面的平均出院成本和住院时间(LOS)的变化，以及医疗保健组织的增长。将这些变化与趋势进行比较。描述医院行为与付款人、医院特征和市场层面信息之间的关系。2)通过检验医院对网络激励的成本和每次出院损失的反应模型，估计“网络”效应的程度。检验关于医院对管理性医疗的反应的辅助假设。3)从管理型医疗计划参与者的角度出发，发展出一个“最优网络”理论。使用这一点来描述计划应如何决定网络结构和网络中的重定向模式。4)对照最优网络理论的预测，检验管理型医疗计划的行为。

It is not uncommon to see cost savings of 30 percent of mental health costs in connection with the introduction of managed care. Providers respond to managed care by doing less in ways that cannot be explained by utilization review or supply-side price incentives. It appears that the opportunity to be included within the managed care works a powerful incentive. We define a "network" as a subset of the providers in a market selling services to a managed care plan on favorable terms (to the plan). In exchange, the plan directs business to the providers in the networks. We propose to study the effect of networks on the quantity of care supplied to patients, using data spanning three rounds of network creation within a state-level market for hospital services. We will also study the problem of network design. We will develop and test a theory of an "optimal network" that balances the gain in bargaining power and information to the payer against the loss in choice for consumers. The market for hospital care for mental health and substance abuse in Massachusetts is an excellent site for the study of network effects. Hospitals have undergone three rounds of network formation in connection with carve-out plans, two carve outs in Medicaid and one in the largest private employer in the state, the Group Insurance Commission. Furthermore, hospitals have experienced the growth of HMOs using networks of hospitals to care for their enrollees. This setting thus offers an opportunity to test the impacts of network creation on patient care, health plan costs, and the provider industry, and to study the problem of design of the "optimal" network. The proposal has four specific aims: 1) Describe the changes in average discharge cost and length of stay (LOS) at the hospital level in Massachusetts in association with the introduction of three rounds of networks, and the growth of HMOs. Compare these changes to trends. Describe the relation between hospital behavior and payer, hospital characteristics, and market-level information. 2) Estimate the magnitude of the "network" effect by testing a model of hospital response in cost and LOS per discharge to network incentives. Test subsidiary hypothesis about hospital response to managed care. 3) Develop a theory of an "optimal network" from the point of view of the enrollees in a managed care plan. Use this to describe how a plan should decide on the structure of the network and on the pattern of redirections in the network. 4) Test the behavior of the managed care plans against the predictions of the optimal network theory.