Utilization and costs of substance abuse services within The HMO Group.

This paper describes the organizational characteristics, benefit coverage, referral pathways, utilization rates, and costs of substance abuse services within 17 HMOs belonging to The HMO Group in 1990. All 17 health plans responded to the questionnaire. Responses to the survey reflected the complexity of HMO substance abuse services. Overall, The HMO Group members provided substance abuse service coverage partly dependent upon state mandates, employer group priorities, and local competitive benefit structures. The HMOs reported that service utilization rates and the productivity of their substance abuse providers were critical information needs currently not fully reported. Overall, the survey responses reflected the need for improvement of clinical information systems and expansion of the aggregate substance abuse database.