Risk sharing in managed behavioral health care.

Area of Science:

• Health Services Research
• Behavioral Health Economics
• Healthcare Policy

Background:

• Policymakers are concerned about how risk-sharing arrangements with healthcare providers influence treatment delivery.
• Existing research provides limited conclusive evidence to guide policy decisions on provider payment models.
• Managed behavioral health organizations (MBHOs) are exploring alternative payment structures beyond traditional fee-for-service.

Purpose of the Study:

• To evaluate the impact of transitioning from a fee-for-service to a case-rate payment system on mental health treatment patterns.
• To assess how delegated utilization management within a case-rate model affects healthcare utilization.
• To identify provider characteristics that moderate the relationship between risk-sharing contracts and treatment intensity.

Main Methods:

• Quasi-experimental evaluation of a contracting change within a managed behavioral health organization.
• Comparison of mental health visit frequency before and after the implementation of a case-rate system.
• Analysis of how case rate value and provider revenue mix from risk contracts influence utilization.

Main Results:

• The shift to a case-rate system with delegated utilization management led to a 25% reduction in mental health visits per episode.
• The magnitude of this reduction was associated with the dollar value of the case rate.
• Providers with a greater proportion of revenue from risk contracts and those employing intensive utilization management showed a more significant decrease in visits.

Conclusions:

• Risk-sharing payment models, specifically case rates with delegated utilization management, can significantly alter provider treatment patterns by reducing service utilization.
• The financial structure of risk contracts and the intensity of provider-led utilization management are key factors influencing the effectiveness of these payment reforms.
• Findings provide empirical evidence for policymakers considering the design and implementation of value-based payment models in behavioral healthcare.