SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of...
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Transcript of SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of...
![Page 1: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/1.jpg)
SYSTEMS OF CARE
Behavioral Science Lecture
John Fortney, Ph.D.
Assistant Professor, Department of Psychiatry, UAMS
![Page 2: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/2.jpg)
Rationale for Managed Care Versus Fee For Service
• Exponentially rising health care costs
• Moral hazard
• Geographic variations in treatment costs and patterns
• Evidence of supplier-induced demand for health care
![Page 3: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/3.jpg)
National Health Expenditures in the U.S.
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1960 1965 1970 1975 1980 1985 1990 1995Year
Per
Cap
ita
(in
Do
llar
s)
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Price Adjusted Medicare Reimbursements for Outpatient Services
Source: The Dartmouth Atlas of Health Care 1998
![Page 5: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/5.jpg)
Ration of Rates of Hospitalization for Hip Fracture to the U.S. Average (1994-95)
![Page 6: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/6.jpg)
Ratio of Hospitalization for Forearm Fracture to U.S. Average
![Page 7: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/7.jpg)
Predicted and actual average lengths of stay of patients treated for depression at 107 Veterans
Affairs medical centers
![Page 8: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/8.jpg)
Acute Care Hospital Resources and the Medical Signatures of the Boston and New Haven Hospital
Service Areas (1994-95)
![Page 9: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/9.jpg)
The Association Between Allocated Hospital Beds and Medicare Hospitalizations for Medical and Surgical Care and for Hip Fracture (1994-95)
![Page 10: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/10.jpg)
Managed Care Cost-Containment Strategies
• Cost Sharing
• Risk sharing
• Utilization review
• Gate keeping
• Provider Choice Restriction
• Carve-outs
![Page 11: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/11.jpg)
Types of Managed Care Organizations
(understanding the alphabet soup)
• FFS: Fee-For-Service (with utilization review)
• HMO: Staff and Group Model Health Maintenance Organizations
• IPA HMO: Independent Practice Association Health Maintenance Organizations
• PPO: Preferred Provider Organizations
• POS: Point of Service plans
![Page 12: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/12.jpg)
Relationship Between Health Plan Characteristics and Type of Plan
Type of Plan Prepaid Gatekeeper Partial Out-of-Plan Coverage
No Out-of-planCoverage
Carve-Out
FFS - - - - +/-HMO + + - + +/-POS +/- + + - +/-PPO +/- - + - +/-
“+” indicates that the characteristic is present.“-“ indicates that the characteristic is not present.“+/-“ indicates that the characteristic may or may not be present.
![Page 13: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/13.jpg)
Trends in Managed Care
• Types of health plans
• Employer self-insured
• Benefits structure
• Managed care in Arkansas
![Page 14: SYSTEMS OF CARE Behavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS.](https://reader035.fdocuments.in/reader035/viewer/2022062719/56649ef35503460f94c0524f/html5/thumbnails/14.jpg)
Primary Medical Plan Type
Source: Hay Group Management, Inc. May 1998
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Behavioral Health Care Benefits as a Percent of Total Health Care Benefits
0
1
2
3
4
5
6
7
Year 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
Year
Pe
rce
nt
Source: Hay Group Management, Inc. May 1998
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Health Maintenance Organizations’ Enrollment in Arkansas in 1996
Source: Arkansas Department of Health
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Enrollment in Managed Care Organizations in Arkansas in 1998
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
Nu
mb
er o
f E
nro
llee
s
Source: Arkansas Insurance Department, 1998
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Contracted Physicians’ in Managed Care Organizations in Arkansas in 1998
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000N
um
be
r o
f P
hys
icia
ns
Source: Arkansas Insurance Department, 1998
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Managed Care: How It Affects Clinical Practice
• Contracting with health plans
• Provider profiling
• Utilization review
• Risk sharing
• Integrated versus carved-out psychiatric treatment