Changing Mental Health Gatekeeping: Effects on Performance Indicators

• Published in: The journal of behavioral health services & research Vol. 35; no. 1; pp. 3 - 19
• Main Authors: Merrick, Elizabeth Levy, Hodgkin, Dominic, Horgan, Constance M., Garnick, Deborah W., McLaughlin, Thomas J.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.01.2008; Springer Nature B.V
• Subjects: Adolescent; Adult; Authorization; Business metrics; Call centers; Community and Environmental Psychology; Divisions; Female; Gatekeeping - organization & administration; Health Informatics; Health maintenance organizations; Health Promotion and Disease Prevention; Health Psychology; HMOs; Humans; Insurance Claim Review; Male; Massachusetts; Medicine; Medicine & Public Health; Mental health care; Mental health services; Mental Health Services - statistics & numerical data; Middle Aged; Performance indicators; Psychiatry; Public Health; Quality Indicators, Health Care; Regular Article; Service provision; Studies; gatekeeping; quality of care; mental health; managed care
• ISSN: 1094-3412; 1556-3308
• DOI: 10.1007/s11414-007-9077-z

This study evaluated how a change in gatekeeping model at a health maintenance organization affected performance indicators for specialty outpatient mental health care. Gatekeeping in one division changed from in-person evaluations to a call center with routine authorization for the first eight visits. Using 1996–1999 claims data (including 2 years pre- and 2 years postintervention), the study compared performance indicator results in the affected division and another where the model did not change. Subjects included 122,751 continuously enrolled persons. Dependent variables were mental health emergency room use, treatment initiation, treatment engagement, and family treatment for child patients. After controlling for secular trends at the other division and enrollee characteristics, the division that changed gatekeeping experienced no significant impact on most indicators and an increase in family treatment for children. The move to call-center gatekeeping did not appear to have a negative impact on treatment process as reflected in these indicators.