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New benefit management models.

Article Excerpt
High healthcare costs are forcing all aspects of the behavioral health field to reexamine how they do business. Managed behavioral health organizations such as APS, Magellan, ValueOptions, and United Behavioral Health have reacted by experimenting with disease management and consumer-directed health benefit management models. In the following pages, Behavioral Health Management Editor-in-Chief Monica E. Oss examines the specifics of these MBHOs' approaches, highlighting the challenges--and opportunities--they face.

It appears the era of managed care is waning. Payers--both public sector and private sector--seem to believe that the healthcare cost savings possible through a managed care model cannot be increased.

The numbers seem to support this contention: The cost of employer-sponsored health benefits increased 13.9%, 11.2%, and 9.2% in 2003, 2004, and 2005, respectively, with the cost of corporate health benefits now outpacing the cost of wages.

This situation has led to a decrease in employer-sponsored health benefits and a corresponding increase in government-provided healthcare coverage, while the ranks of the uninsured have grown. For this reason, among others, growth in Medicaid costs is outpacing the rise in state taxes, and Medicare is facing staggering deficits in the near future.

Payers appear ready to embark on two new paradigms for addressing healthcare cost issues. The leading contenders include consumer-directed healthcare and pay-for-performance disease management models. But these options could be in conflict and could result in additional financial discrimination against individuals with chronic disorders, such as mental illnesses and addictions.

Consumer-directed healthcare moves managing healthcare delivery to the end user--the consumer of healthcare services and his/her family. This model prods Americans to be better healthcare shoppers by making them spend more of their own money--often wages shielded from taxes--before health insurance kicks in.

The notion is...

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