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Changing mental health gatekeeping: effects on performance indicators.

Elizabeth Levy Merrick1, Dominic Hodgkin, Constance M Horgan

  • 1Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02454-9110, USA. merrick@brandeis.edu

The Journal of Behavioral Health Services & Research
|July 28, 2007
PubMed
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A health maintenance organization

Area of Science:

  • Health Services Research
  • Mental Health Services
  • Healthcare Management

Background:

  • Health maintenance organizations (HMOs) often implement gatekeeping models to manage specialty mental health care access.
  • Changes in gatekeeping strategies can potentially impact patient access, treatment initiation, and engagement.
  • Evaluating these impacts is crucial for optimizing healthcare delivery and patient outcomes.

Purpose of the Study:

  • To assess the effect of a gatekeeping model change from in-person evaluations to a call center with routine authorization on mental health care performance indicators.
  • To compare outcomes in a division that altered its gatekeeping process with a control division where the model remained unchanged.

Main Methods:

  • Utilized claims data from 1996-1999 (2 years pre- and 2 years post-intervention) for 122,751 continuously enrolled individuals.

Related Experiment Videos

  • Compared performance indicators including mental health emergency room use, treatment initiation, treatment engagement, and family treatment for child patients.
  • Controlled for secular trends and enrollee characteristics between the intervention and control divisions.

    • Main Results:

    • The division implementing the call center gatekeeping model showed no significant negative impact on most performance indicators.
    • An increase in family treatment for child patients was observed in the intervention division.
    • The shift to call-center based gatekeeping did not adversely affect the treatment process as measured by the selected indicators.

    Conclusions:

    • Transitioning to a call center gatekeeping model in an HMO setting did not negatively affect key performance indicators for specialty outpatient mental health care.
    • The new model was associated with an increase in family treatment for children, suggesting potential benefits for pediatric mental health services.
    • This study indicates that gatekeeping model modifications can be implemented without compromising essential treatment processes in mental health care.