Mental Health Care in Region 8: Preparing for Tricare.
Final rept. Jul 95-Dec 96,
ACADEMY OF HEALTH SCIENCES (ARMY) FORT SAM HOUSTON TX HEALTH CARE ADMINISTRATI ON
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The military health services system is under increasing pressure to justify its existence, redefine its role, and control costs. TRICARE evolved in 1993 as a managed care program to ensure a high-quality, consistent health benefit, improve access, and contain costs. Mental health and substance abuse MHSA services offer a unique challenge for management under TRICARE in Region 8. The purposes of this project were to determine utilization trends and to evaluate the feasibility of using key management indicators to estimate the annual MHSA cost per CHAMPUS-eligible beneficiary. Utilization and cost data for fiscal years 1993 and 1994 were analyzed for CHAMPUS MHSA services provided in 14 catchment and 12 non-catchment areas in Region 8. The results provide a baseline for MHSA utilization prior to TRICARE. Although beneficiaries aged 0-17 represented only 36 percent of the population, they accounted for more than 64 percent of MHSA costs. The top five MHSA diagnoses accounted for almost 90 percent of utilization and government costs. Furthermore, key management indicators are reliable predictors of the mental health cost per beneficiary. These indicators will become valuable parameters to gage the performances of both the direct care system and the TRICARE contractor and to benchmark against industry standards.
- Medicine and Medical Research