Payer Pressure on MBHOs Can Improve Psychiatric Care

Pressure from a patient or payer often rectifies situations where managed behavioral health care organizations (MBHO) are providing poor psychiatric treatment, advised Susan M Essock, PhD. 

In her recently published editorial, Dr Essock described several hypothetical situations resulting in insufficient or inadequate care, and drew from her own experiences on the side of the patient and the payer to recommend effective strategies when dealing with an underperforming (MBHO).

MBHOs for psychiatric care were relatively uncommon in the US prior to 1990, when the IBM Corporation made news by enrolling its approximately 700,000 employees into managed psychiatric care, Dr. Essock wrote in JAMA Psychiatry. In contrast, MBHOs — the “800-lb gorilla in mental health care” — are so commonplace in the current market that Americans accessing mental health care routinely have their care authorized by MBHOs as a precondition for payment. 

The size of these organizations may also complicate patients’ care. In these situations, such as when one is unable to find an in-network appointment for “urgent” mental health issues, Dr Essock recommended patients petition the employee’s benefit manager for support. 

“In my experience, benefit managers get surprisingly few of these calls and promptly push the MBHO when they do,” Dr Essock wrote. “Benefits managers are charged with monitoring vendors’ performance under the contract, so they know what situations violate contractual expectations and will follow up accordingly.”

Her advice was similar for when a patient in need of care is being discharged prematurely. In these situations, however, Dr Essock noted appeals with the vendor or psychiatrists who are not on the MBHO as additional options.

Conversely, Dr Essock also warned of MBHOs whose plans are providing insufficient or problematic psychiatric care. Situations where treatment plans may inadvertently be perpetuating illness or an MBHO is prematurely discharging patients to short underfunded contracts are tricky, she wrote, as patients and providers may not be in a position to gauge an MBHO’s support. Outside of the action from state insurance commissioners or attorneys, only payers can prevent these conditions by enforcing contract terms.

“There are ways to pressure MBHOs to do the right thing. That said, sometimes a vendor’s no averts poor care or reflects the payer’s in-sufficient funding to provide needed care,” Dr Essock concluded. —Dave Muoio