Recorded presentation

Dominic Hodgkin, PhD¹, Elizabeth L. Merrick, PhD, MSW², Constance M. Horgan, ScD³, and Deborah W. Garnick, ScD³. (1) Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, 781-736-8551, hodgkin@brandeis.edu, (2) Schneider Institute for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02454, (3) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454

A number of managed health plans have recently abandoned or diluted their use of gatekeeping approaches to control utilization, in response to a backlash from consumers and providers. However, some plans reportedly are concerned about relaxing gatekeeping for behavioral health care, as this might drive up utilization. The present study reports on the utilization experience of one HMO that removed a gatekeeping restriction. Before 1998, the HMO we study required patients in one division to receive a face-to-face evaluation before entering outpatient specialty mental health treatment. Starting in 1998, the HMO stopped requiring face-to-face evaluation, and enrollees only had to call a toll-free referral line to receive routine preauthorization for the first 8 sessions. We examine trends in access and utilization of specialty mental health care among the continuously enrolled during two years before and two years after removal of the restriction, using insurance claims and enrollment data. To control for potential confounding factors, we also examine utilization trends in another division of the same HMO that never had this restriction. Preliminary results indicate that in the division where policy changed, the proportion of enrollees accessing specialty mental health treatment increased somewhat after removal of the restriction. However, we find a similar increase occurred at the division where there was no policy change, suggesting that the increase may have resulted from other factors. Ongoing work is exploring whether the change had more visible effects for people newly entering treatment.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Distinguish among different models of gatekeeping for behavioral health (face-to-face, call center)
• Understand the implications of each model for patients' entry into treatment and access to care.

Keywords: Access, Managed Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation