The proposed research seeks to expand knowledge of the nature and determinants of ways in which health maintenance organizations (HMOs) organize and deliver services in the areas of mental health and combined alcohol, drug abuse, and mental health (ADM). It is particularly concerned with the implementation and impact of strategies directed at managing the utilization and cost of mental health care in HMOs. This study builds directly on previous research supported by contract #278-86-0019(BA) from the NIMH, in which the investigators conducted a nationwide survey of HMOs to collect 1985 data on ADM benefits, delivery systems, staffing patterns, treatment modalities, referral paths, utilization, payment mechanisms, and costs. The proposed research includes conducting a 1988 survey of HMOs covering mental health and combined ADM services, which permits comparisons of findings on delivery approaches, utilization, and costs in 1988 to those from the 1985 survey, as well as to data from previous studies conducted by others. In addition, a more intensive multivariate analysis of the 1988 survey data pertaining to mental health care will be conducted. In addition to the survey responses, this analysis will incorporate data on HMO characteristics from InterStudy's longitudinal national HMO data base, health-related statistics on communities from the Area Resource File, data to be collected on mandated ADM benefits and hospital rate regulation by conducting a telephone survey of state regulators, and data on Blue Cross/Blue Shield mental health benefits to be collected by telephone survey. This part of the data analysis is guided by a """"""""strategic adaptation"""""""" conceptual framework that draws on theoretical and empirical work from the fields of sociology and economics. It will examine relationships (a) between specific organizational strategies for managing mental health services and a set of independent variables that include HMO and environmental characteristics, and (b) between these organizational strategies and the utilization and costs of mental health care, controlling for other relevant factors. Products of the research include a detailed report of descriptive findings, including 1985-88 comparisons; a chartbook that summarizes the findings; a series of professional publications; and a fully documented tape containing the 1985 and 1988 data to be made available to other investigators by the National Institute of Mental Health.
