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Biomedical subjects

K L Grazier

Publications and source records attributed to K L Grazier.

At least 19 recordsLinked to original sources
PubMed2000

Translating behavioral health services research into benefits policy.

This article uses a 4-pronged statistical approach to examine the impact of a mental health carve-out at a major employer. To examine net financial impact of the carve-out, the authors perform a pre-post, multivariate regression analysis of changes in costs. Using a random-effects model, the authors explore the ultimate financial impact of the carve-out for patients and for the firm. Using a multinomial logistic regression, they examine differing program effects by intensity of use. A fixed-effects negative binomial regression models the episodic nature of outpatient care, controlling for patient-specific unobserved characteristics that influence health care utilization. The carve-out slightly reduced overall mental health costs and utilization while expanding entry-level access to routine services. At the same time, the specific carve-out shifted financial burdens from the firm onto high-utilization patients. Therefore, this carve-out appears poorly suited to the care of individuals experiencing severe and debilitating psychiatric disorders.

Adult↗
PubMed1999

Effects of a mental health carve-out on use, costs, and payers: a four-year study.

This study examines the effects of a mental health carve-out on a sample of continuously enrolled employees (N = 1,943) over a four-year time frame (1990-1994). The article presents a health care services utilization model of the effect of the carve-out on outpatient mental health use, cost, and source of payment in the three years post implementation relative to the year prior to the carve-out model. In the first three years of the carve-out, the likelihood of employees seeking mental health care increased in significant part because of the carve-out. For the outpatient mental health services user, the carve-out was not associated with the level of mental health services received. The carve-out was significantly associated over time with a reduction in the patient's and employer's mental health costs. This effect was more pronounced in the second and third years of the carve-out. The article explores the policy implications of these and other findings.

Adult↗
PubMed1999

Mental health carve-outs: effects and implications.

To control the rise in expenditures and to increase access to mental health and substance abuse (MH/SA) services, a growing number of employers and states are implementing a "carve-out." Under this arrangement, the sponsor separates insurance benefits by disease or condition, service category, or population and contracts separately for the management of care and/or associated risks. A carve-out allows a unique set of managed care techniques to be applied to a subset of particularly costly or complex benefits. This article describes various carve-out models, discusses the potential advantages and disadvantages of a full carve-out, and summarizes recent public and private sector research regarding the strategy's effects on access and use, cost savings and shifting, and quality of care. It concludes by discussing approaches to the assessment and monitoring of the processes and outcomes associated with a MH/SA carve-out.

Contract Services↗
PubMed1992

Institutions for Mental Diseases (IMDs): facilities and clients.

This paper describes a cross-sectional study of institutions for mental diseases (IMDs) and the clients they serve in one state. Primary and secondary data were collected to provide an in-depth look at the demographic, social, behavioral, medical, psychiatric and treatment attributes of a random sample of clients in IMDs. Detailed financial, service and operational data were collected on a 100% sample of facilities in the state. The findings indicated a client population dissimilar in age and behavioral attributes from a typical nursing home patient, but in keeping in many respects with the descriptions of nursing home clients with psychiatric disorders. Facilities appeared similar to nursing homes in their size and many operations. This unique database can be used to explore a predictive resource model of these institutions as well as to begin to examine the quality and effectiveness of this form of institutional care for the severely mentally ill.

Adult↗
PubMed1986

Factors affecting choice of health care plans.

The research reported here examined the factors which affected the decision to remain with either Blue Cross of Washington and Alaska or Group Health Cooperative of Puget Sound, or to change to an independent practice association (IPA) in which the primary care physicians control all care. The natural setting allowed examination of the characteristics of families with experience in structurally different plans; a decision not influenced by premium differentials; the importance of the role of usual provider; and a family-based decision using multivariate techniques. An expected utility model implied that factors affecting preferences included future need for medical care; access to care; financial resources to meet the need for care; and previous level of experience with plan and provider. Analysis of interview and medical record abstract data from 1,497 families revealed the importance of maintaining a satisfactory relationship with the usual sources of care in the decision to change plans. Adverse selection into the new IPA as measured by health status and previous utilization of medical services was not noted.

Blue Cross Blue Shield Insurance Plans↗