Behavioral Health and Substance Abuse Treatment: Managed Care Eliminated Providers and Services

Integrated Paper Sims

Managed healthcare took over third party reimbursement processes and promised to control cost of care through managing benefit authorization. Behavioral health and substance abuse services were not viewed favorably not because of a lack of demand and high supply, but for reasons of profitability and the costs of doing business. Behavioral Health treatment included a continuum of care with various treatment modalities such as hypnosis, biofeedback, group therapy, marital/family therapy, and all levels of care. Specific child and adolescent treatment with a focus on family therapy and the importance of appropriate assessment and diagnosis of childhood disorders helped families and individuals. Advances in treatment and access to various treatment modalities began to demonstrate correlated outcomes and successes when managed care

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entered the picture. Prior to managed care, health insurance was paying for most treatment modalities and all levels of care as determined by providers as necessary. Behavioral Health and Substance Abuse (BH/SA) treatment quality and innovation will take decades to return to that innovative professional level. Treatment needs of the populations and the social stigma attached to those persons with substance abuse and mental illness have gone backward over the past 20 years. What wasn’t considered by the near elimination of BH/SA treatment, was the impact of overall healthcare costs. Decreasing appropriate mental health and substance abuse treatment may have increased the escalating healthcare costs as well as the social costs of untreated mental illness and substance abuse. Parity law didn’t make significant impacts to healthcare plans for reimbursement for behavioral health treatment and the original law didn’t include language related to substance abuse treatment service specifics. Managed care failed to contain escalating healthcare costs. However, the denial of reimbursement for appropriate levels of care for addiction and psychotherapeutic treatment may have increased some healthcare costs because they denied reimbursement for treatment. Primary care medicine has become the de facto mental health care system whether it is the correct point of service and the costs spent add to the overall healthcare expenditure. (Klingsbury, 2008) People see their physician often for psychologically based symptoms and no medical treatment is necessary, but costs are paid for those physician office visits. Primary care medicine treats symptoms that are psychologically and emotionally based. Estimated 60-70% of primary care physician (PCP) visits do not receive med care b/c the symptoms are psychologically based- manifesting phys symptoms. (Kaiser) Expenditures in the United States on health care surpassed

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$2.3 trillion in 2008, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. (Kaiser) 21% of the $2.3 Trillion expenditure reportedly is physician costs and of that an estimated 15% is primary care. So, how much of this figure could be attributed to behavioral health and substance abuse disorders either seeking primary care or higher levels of care which requires or may not require medical care? Using the 60% figure of primary care visits and the 2008 expenditure figure of $2.3T, it could be estimated at. $20.7B. (Refer to Appendix 1, Figure 1) Behavioral Health treatment was just beginning to eliminate the atrocities of the treatment approaches and develop innovative and creative therapeutic approaches when the managed care practices entered the picture. During the Reagan administration, Mental Health reform made impacts related to the involuntary commitment laws, and clarified the availability to involuntary commitments to be limited to those individuals who were deemed a danger to themselves or others. (Articles for MH