私人健康保险计划与管理式行为医疗保健组织的合同。
Private Health Plans' Contracts with Managed Behavioral Healthcare Organizations.
作者信息
Garnick Deborah W, Horgan Constance M, Merrick Elizabeth L, Hodgkin Dominic, Reif Sharon, Quinn Amity E, Stewart Maureen, Creedon Timothy B
机构信息
Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, 02454, Waltham, MA, USA.
出版信息
J Behav Health Serv Res. 2017 Jan;44(1):149-157. doi: 10.1007/s11414-015-9474-7.
Contracts between health plans and managed behavioral health care organizations (MBHOs) influence access and quality of behavioral health care. This report presents information on performance requirements, information sharing, and financial risk from a nationally representative survey of private health plans. Most contracts include geographic access to providers (93.3%) and NCQA’s performance standards (84.2%). Health plans and MBHOs share data (99.0%), generally by the MBHO sending information to the health plan (96.3%). About a quarter of contracts impose financial penalties (23.0%), but few include incentives related to performance standards (<1.0%). Contract terms can shape the provision of behavioral health services in response to changes such as parity legislation or health reform. If current trends continue towards increases in value-based purchasing in the privately financed behavioral health sector, the focus on quality in contracts between health plans and MBHOs will be critical to understand.
健康计划与管理式行为健康护理组织（MBHOs）之间的合同会影响行为健康护理的可及性和质量。本报告呈现了一项针对全国代表性私人健康计划的调查中有关绩效要求、信息共享和财务风险的信息。大多数合同包括提供者的地理可及性（93.3%）和国家质量保证委员会（NCQA）的绩效标准（84.2%）。健康计划和MBHOs会共享数据（99.0%），通常是由MBHOs向健康计划发送信息（96.3%）。约四分之一的合同会施加财务处罚（23.0%），但很少有合同包含与绩效标准相关的激励措施（<1.0%）。合同条款可以根据平价立法或医疗改革等变化来规范行为健康服务的提供。如果目前在私人融资的行为健康领域基于价值的采购增加的趋势持续下去，那么了解健康计划与MBHOs之间合同中对质量的关注将至关重要。
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