NETWORK EFFECTS IN MENTAL HEALTH MANAGED CARE

在引入管理式护理后，节省了30%的心理健康成本，这并不罕见。提供者对管理式医疗的反应是以不能用利用率审查或供应方价格激励来解释的方式做得更少。 看来，被纳入管理式护理的机会是一个强大的激励因素。 我们将“网络”定义为市场上以优惠条件（对计划）向管理式护理计划销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。 我们建议研究网络对提供给患者的护理数量的影响，使用的数据跨越了三个回合的网络创建在一个国家级的医院服务市场。 我们还将研究网络设计问题。 我们将发展和测试一个“最优网络”的理论，该理论平衡了支付者在议价能力和信息方面的收益与消费者在选择方面的损失。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一个很好的网站。 医院已经经历了三轮与开拓计划有关的网络形成，两次在医疗补助计划中开辟，一次在该州最大的私人雇主集团保险委员会。 此外，医院经历了HMO使用医院网络来照顾其注册者的增长。 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，健康计划成本和供应商行业的影响，并研究“最佳”网络的设计问题。该提案有四个具体目标：1）描述马萨诸塞州医院水平的平均出院费用和住院时间（LOS）的变化，以及三轮网络的引入和HMO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、医院特性和市场水平信息之间的关系。 2)通过测试医院对网络激励的成本和每次出院的服务水平的反应模型，估计"网络"效应的大小。 检验医院对管理式医疗反应的辅助假设。 3)从管理式照护计划的参与者的观点，发展一个“最佳网路”的理论。 用它来描述一个计划应该如何决定网络的结构和网络中重定向的模式。 4)根据最优网络理论的预测，测试管理式医疗计划的行为。

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.