For many clients, added Alexandre Laudet, a principal investigator at NDRI, substance-abuse disorders are chronic, relapsing conditions that cannot be resolved by a short-term treatment episode. In order to address this, service providers and researchers are increasingly seeking to identify effective and cost-effective modalities for substance-abuse problems. As a result, it can be said that the advent of managed care has contributed greatly to emphasizing evidence-based clinical practices.

Indemnity insurance coverage was the prevalent form of health care in the United States 25 years ago. Today more than half of all Americans with health insurance are enrolled in some kind of managed care plan. The predominant forms of MCOs are health maintenance organizations (HMOs), point-of-service (POS) plans, and preferred provider organizations (PPOs). HMOs are the oldest form of MCOs; members are offered a range of health benefits for a set monthly fee, and primary-care doctors act as care coordinators. Some HMOs offer a POS plan, which is an indemnity-type option that allows members to refer themselves outside of the plan for a negotiated fee. A PPO is a form of MCO that is closest in nature to indemnity coverage; members have more flexibility for self-referral but also tend to have more copayments for doctors and/or prescriptions.

One of the studies (Horgan, et al.) in the Magura manuscript found that, outside of inpatient and residential care, PPOs were less likely than HMOs and POS plans to require prior authorization for AOD treatment.

This finding implies that requirements for prior authorization can set up a barrier to receiving timely treatment in situations where a fast response is desirable, said Magura. In addition, when patients and providers do not exactly follow the sometimes involved prior-authorization procedures, reimbursement may be denied. In my opinion, if MCOs establis
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14-Mar-2002