Focused psychiatric review: impacts on expense and utilization.

Area of Science:

• Healthcare Management
• Psychiatric Services
• Health Economics

Background:

• Inpatient mental health care utilization and associated costs are significant concerns for healthcare payers.
• Effective utilization review programs are crucial for managing healthcare expenditures.
• Aetna implemented the Focused Psychiatric Review program to address these challenges.

Purpose of the Study:

• To evaluate the impact of Aetna's Focused Psychiatric Review program on inpatient mental health utilization.
• To determine the program's effect on length of stay, admission rates, and overall healthcare expenses.
• To assess the financial return on investment for the utilization review program.

Main Methods:

• Analysis of inpatient mental health utilization data before and after program implementation.
• Comparison of outcomes for psychiatric versus substance abuse treatments.
• Calculation of program costs and resulting financial savings.

Main Results:

• The Focused Psychiatric Review program successfully reduced length of stay and stabilized admission rates.
• The program demonstrated a greater impact on psychiatric treatments compared to substance abuse treatments.
• Estimated annual net program savings were $34.90 per covered employee, with a $12.60 return for every dollar spent.

Conclusions:

• The Focused Psychiatric Review program is an effective strategy for managing inpatient mental health utilization and reducing healthcare costs.
• The program offers a significant positive return on investment, particularly for psychiatric care.
• Utilization review programs can yield substantial financial benefits for health insurance providers.