SYSTEMS OF CARE Behavioral Science Lecture

1. SYSTEMS OF CAREBehavioral Science Lecture John Fortney, Ph.D. Assistant Professor, Department of Psychiatry, UAMS

2. 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

3. National Health Expenditures in the U.S.

4. Price Adjusted Medicare Reimbursements for Outpatient Services Source: The Dartmouth Atlas of Health Care 1998

5. Ration of Rates of Hospitalization for Hip Fracture to the U.S. Average (1994-95)

6. Ratio of Hospitalization for Forearm Fracture to U.S. Average

7. Predicted and actual average lengths of stay of patients treated for depression at 107 Veterans Affairs medical centers

8. Acute Care Hospital Resources and the Medical Signatures of the Boston and New Haven Hospital Service Areas (1994-95)

9. The Association Between Allocated Hospital Beds and Medicare Hospitalizations for Medical and Surgical Care and for Hip Fracture (1994-95)

10. Managed Care Cost-Containment Strategies • Cost Sharing • Risk sharing • Utilization review • Gate keeping • Provider Choice Restriction • Carve-outs

11. 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

12. Relationship Between Health Plan Characteristics and Typeof Plan

13. Trends in Managed Care • Types of health plans • Employer self-insured • Benefits structure • Managed care in Arkansas

14. Primary Medical Plan Type Source: Hay Group Management, Inc. May 1998

15. Behavioral Health Care Benefits as a Percent of Total Health Care Benefits Source: Hay Group Management, Inc. May 1998

16. Health Maintenance Organizations’ Enrollment in Arkansas in 1996 Source: Arkansas Department of Health

17. Enrollment in Managed Care Organizations in Arkansas in 1998 Source: Arkansas Insurance Department, 1998

18. Contracted Physicians’ in Managed Care Organizations in Arkansas in 1998 Source: Arkansas Insurance Department, 1998

19. Managed Care: How It Affects Clinical Practice • Contracting with health plans • Provider profiling • Utilization review • Risk sharing • Integrated versus carved-out psychiatric treatment