research. It identifies significant research opportunities in areas such as access, costs, utilization, and treatment outcomes, including quality of care. It also examines the formidable barriers to research and the need to ensure the rapid translation of research results into clinical practice. This chapter uses the term ''managed drug abuse care" to refer to the drug abuse component of managed behavioral health care, the branch of managed care that administratively combines the traditionally separate areas of drug abuse and mental health.

OVERVIEW

Managed behavioral health care is characterized by a variety of approaches designed to control the cost of services by altering the treatment decisions of both patients and providers (IOM, 1989; Mechanic et al., 1995). There is no single model of managed behavioral health care, and the various approaches are evolving rapidly in a dynamic and highly competitive market, thereby hampering research efforts to characterize them and to evaluate their impact. The overall goal is to alter the orientation and restrain the costs of behavioral health care through changes in the organization, financing, and delivery of services. By incorporating the elements of managed care, which are described later in this section, projected costs can be reduced by up to 30 or 40 percent, according to some industry estimates (Geraty et al., 1994).

Virtually unheard of a decade ago, the burgeoning industry of managed behavioral health care is estimated to cover more than 102 million people across the United States, most of whom are insured under employer-sponsored private health insurance (Oss, 1994). This estimate represents the majority of those covered under employer health care plans, given that 143 million people in the U.S. population have such coverage (CRS, 1994). The figure of 120 million enrollees refers to those eligible individuals whose private or public insurance covers managed behavioral health care, not to those who receive treatment. According to a recent, nationally representative survey, about 50 percent of specialty drug abuse providers, both publicly and privately owned, report that an average of 23 percent of their clients have their treatment paid for by managed care (T. D'Aunno, University of Chicago, personal communication, 1995).

Managed behavioral health care is offered most commonly through one of two general types of managed care organizations: health maintenance organizations (HMOs) or carve-out vendors (also known as managed behavioral health care organizations or MBHCOs) (Table 9.1). These organizations are under contract mostly to employers and public agencies, which pay for some or all of the cost of care. Carve-out vendors are fiscal and management intermediaries that typically contract with pro-



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