| Abstract: | Managing mental health and substance abuse utilization in a complex network health maintenance organization (HMO) can successfully be accomplished through a comprehensive approach. Prescreening of admissions, and preferred provider contracts are two of the key components of one HMO's managed care system described in this paper. Savings approaching $300,000 in the first year were documented and formulas for tracking savings are described. These savings were the result of averting unnecessary admissions. Additional savings resulted from contract discounts from preferred providers and utilization of short term facilities. Increased physician and patient satisfaction, coupled with meeting the HMO's goal of quality, appropriate, cost-effective and humane care have benefited patient and insurer alike.This paper was prepared for the American Public Health Association 115th Annual Meeting.  Health Care for People or for Profit. Tuesday, October 20, 1987. New Orleans, Louisiana. The authors wish to acknowledge David Segal, M.M., Manager of Rates and Underwriting, Harvard Community Health Plan, for his contribution to the Financial models.Nancy Langman-Dorwart, M.S., M.P.H., Manager of Mental Health and Chemical Dependency, Private HealthCare Systems, LTD., 620 Maguire Rd., Lexington, MA 02173.Thomas Peebles, M.D., Medical Director, General Associates, Weston, MA. |
