Managed behavioral health care organizations (MBHOs) dominate the market for private mental health coverage, with 63% of insured persons enrolled in a specialty program. Understanding the services received by MBHO enrollees and the implications for costs and outcomes is critical for improving behavioral health care delivery, yet the paucity of outcomes data has heretofore limited our ability to examine these issues. This study addresses the issue of what we can learn about MBHO treatment patterns, expenditures and outcomes by linking administrative and outcomes management data, with the long-term goal of using these data for broader research efforts, such as studying the cost-effectiveness of guideline-concordant care, provider profiling, and optimal provider feedback mechanisms. The study represents a collaborative effort with PacifiCare Behavioral Health (PBH), which is the 8th largest MBHO in the U.S. and has a population clinically similar to that of other large MBHOs. PBH is one of only two MBHOs collecting outcomes data and the only one collecting such data through mandatory provider participation in an outcomes management system. The proposed collaboration offers an invaluable opportunity to look at the effectiveness and expenditures associated with psychotherapy in a """"""""real-world"""""""" MBHO setting. The study aims are to: (1) Construct a merged MBHO database using referral, outcomes, provider, benefits and 2000 Census block/tract data linked to inpatient, outpatient and drug claims; (2) Examine the relationship of patient and provider characteristics with treatment patterns (number of psychotherapy visits, psychotropic drug use, psychiatric hospitalizations, outpatient and inpatient expenditures); (3) Use single-equation and instrumental variables methods to estimate """"""""dose response,"""""""" i.e., how psychotherapy visits are associated with outcomes and expenditures. Selection models will be used to estimate this relationship for patients with and without drug use.
