Oversight of managed care for behavioral health services

Contract specifications for behavioral health services can be used to ensure that services are accessible, efficient, and effective. Staff-per-population ratios and service utilization rates derived from the health services research literature, are proposed as a practical set of performance indicators. Structural, process, and outcome indicators are included. Examples include therapist full-time equivalents per 1000 cases (structural), number of crisis calls per 1000 enrollees (process), and number of emergency department visits per 1000 (outcome). The need for occasional clinical audits and further research in other areas is discussed.