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Biomedical subjects

B Cuffel

Publications and source records attributed to B Cuffel.

9 recordsLinked to original sources
PubMed2001

Analysis of a managed psychiatric disability program.

The cost of mental illness to employers has been well documented; however, efforts to effectively reduce the costs of psychiatric disability are adversely affected by the fragmentation of health care services. This report is a case study of a program in which a managed behavioral health care organization managed the psychiatric disability of a telecommunications company. Compared with a non-random cohort of claimants not managed under the pilot, the duration of disability was reduced by 23% (17.1 days). Patient and provider satisfaction with the program was high. This study illustrates the potential for effectively reducing the cost of psychiatric disability and the challenges in coordinating health care.

Adult↗
PubMed2000

Patients' and providers' perceptions of outpatient treatment termination in a managed behavioral health organization.

OBJECTIVE: A common complaint about managed care is that treatment decisions of patients and providers are frequently altered by concurrent review of ongoing outpatient treatment. The objective of this study was to examine this perception from the perspectives of patients and providers. METHODS: A total of 190 patients and their providers were surveyed about the reason that outpatient treatment was terminated. The sample was randomly drawn from completed outpatient treatment episodes of a large national managed behavioral health organization. RESULTS: In more than three-quarters of the cases, outpatient treatment ended because patients and providers agreed that treatment goals were partially or completely met. Only 5 percent of patients and 3 percent of providers said that treatment ended because the managed care organization denied ongoing treatment. Agreement between patient-provider pairs was generally poor regarding the perceived reason for termination, except when termination was attributed to concurrent review by the managed behavioral health organization. CONCLUSIONS: In this study of a single large managed behavioral health organization, outpatient treatment was most likely to end based on the decisions of patients and providers rather than utilization review decisions.

Adult↗
PubMed1998

Outpatient utilization patterns of integrated and split psychotherapy and pharmacotherapy for depression.

OBJECTIVE: This exploratory study examined utilization and costs among depressed patients in two treatment models-integrated treatment, in which psychotherapy and pharmacotherapy were provided by a psychiatrist, and split treatment, in which pharmacotherapy was provided by a psychiatrist and psychotherapy by a nonphysician psychotherapist. METHODS: A quasi-experimental retrospective design was used to compare claims data from a national managed mental health care organization for 191 patients in integrated treatment and 1,326 in split treatment. RESULTS: During the 18-month study, patients receiving integrated treatment used significantly fewer outpatient sessions and had significantly lower treatment costs, on average, than those in split treatment. Integrated treatment appeared to be associated with a pattern of utilization characterized by frequent treatment episodes in contrast to that of split treatment, which was characterized by more sessions with fewer breaks of 90 days or more. CONCLUSIONS: The results do not support the prevailing assumption that integrated treatment is more costly than split treatment in a managed care network. Despite limitations in the study methods, the strength of these preliminary findings poses a powerful challenge and invites further study.

Adolescent↗
PubMed1997

Disruptive behavior and the determinants of costs in the public mental health system.

Efforts to increase the cost-effectiveness of public mental health systems are hindered by inadequate information about the determinants of use and cost. This paper reviews empirical research and theory suggesting that costs in the public health system are affected more by the disruptive behavior of persons with severe mental illness than by their age, sex, race, and diagnosis, which have been the focus of most economic studies. The author proposes modifications of traditional theories of health service use to explicitly account for the role of disruptive behavior in determining public mental health system costs. He describes a help-seeking pathway in the public mental health system in which the decision to seek treatment is initiated not by the mentally ill person but by others affected by the person's disruptive behavior. This "other-determined" pathway into treatment is contrasted with the self-determined pathway in which an individual with distressing symptoms makes a rational choice to seek help. Empirical research consistent with the other-determined perspective will help target clinical interventions and system reforms to the factors responsible for high-cost mental health care and will improve the ability to predict resource use from observable clinical characteristics of consumers.

Cost-Benefit Analysis↗
PubMed1993

A specialized mental health plan for persons with severe mental illness under managed competition.

Many concerns have been raised about the special problems of providing care for severely mentally ill persons in a reformed health care system based on managed competition. The authors describe what will likely be basic features of the reformed system and discuss potential problems in serving this population. The authors recommend the development of special mental health maintenance organizations (MHMOs) that would serve only persons with severe mental illness. The MHMO would emphasize case management in the community and would provide a fixed point of responsibility for clinical care of these patients. Two methods of reimbursing MHMOs are proposed. Each region's health insurance purchasing cooperative (HIPC) could reimburse the MHMO on a capitated risk-adjusted basis. Alternatively, HIPCs could require the general health plan to operate or contract for MHMOs. In each case, the HIPC would provide quality-of-care oversight and assign a team to act as a gatekeeper for referrals to the MHMO.

Competitive Medical Plans↗
PubMedDate not supplied

Economic consequences of comorbid depression, anxiety, and allergic rhinitis.

The present study extends prior work on the association between allergic rhinitis (AR) and common mental disorders by testing three related hypotheses: 1) that AR is associated with increased rates of depression and anxiety disorders in a large insured population, 2) comorbid AR, depression, and anxiety are associated with increased health and mental health expenditures, and 3) allergy treatment moderates the association between increased expenditures and comorbid AR, depression, and anxiety. Data are from MARKETSCAN, a large health care claims database of over 600,000 privately insured persons. Results indicate that AR is associated with higher rates of depression and anxiety disorder. Outpatient health care expenditures were increased by an average annual amount of $207 when AR and anxiety disorder were comorbid and $363 when AR and depression were comorbid. Finally, prescription treatment of AR moderated the increased expenditures associated with comorbidity.

Adolescent↗
PubMedDate not supplied

More evidence for the insurability of managed behavioral health care.

Debate continues about the cost and use of mental health services under managed care, as legislators consider various "parity" bills. This descriptive research replicates, broadens, and expands previously published case studies of single employers' data on cost and treatment prevalence in a large, diverse, national sample whose varied point-of-service benefits were provided by thirty employers representing multiple industries. Of those covered, 59,005 received treatment over the seven years studied. Of particular note is the pattern of increased use, increased care within the managed behavioral health organization network, and long-term cost reductions.

Behavior Therapy↗