Access and Utilization of New Antidepressant and Antipsychotic Medications. C. Large Integrated HMOs

01/01/2000

In order to examine a more typical arrangement, The Lewin Group decided to focus on integrated health maintenance organizations (HMOs) for this study. Consequently, The Lewin Group identified participants based on the following criteria:

  • Receive favorable NCQA ratings;
  • Offer nationally-recognized behavioral health programs;
  • Cover over 500,000 lives;
  • Operate under at least one of the following models: group, staff, network, PPO; and
  • Operate in geographically diverse regions.

Additionally, the pool of HMOs interviewed were required to represent a variety of financing mechanisms and risk-sharing arrangements (i.e., fee-for-service, capitation) as well as pharmacy management models (i.e., in-house, carve-out). The final HMOs selected included: FirstOption, Harvard Pilgrim, HealthPartners, Group Health, and Kaiser Permanente.

HMO Reason For Inclusion
First Option (New Jersey) (250,000, consolidated w/Physicians Health Services as of 1/2000)
  • Reputation for providing comprehensive coverage and quality care.
  • Good reputation for substance abuse coverage
  • Contacts at The Lewin Group
  • Well-liked in behavioral health community
  • Reputation for good benefits
  • Group model and PPO
  • Carve-out pharmacy benefit
Harvard Pilgrim (1.6 million)
  • New England
  • Group model and PPO
  • Provide continuum of behavioral health care
  • Depression screening program for enrollees and non-enrollees
  • Internally manage pharmacy benefit
HealthPartners (Minnesota) (800,000)
  • Midwest
  • Staff and network models
  • Provide continuum of behavioral health care
  • Established collaborative program between behavioral health specialists and primary care physicians
  • Internally manage pharmacy benefit
Group Health Cooperative of Puget Sound (Washington) (600,000)
  • Pacific Northwest
  • Staff and network models
  • Internally manage pharmacy benefit
Kaiser Permanente Mid-Atlantic (540,000)
  • Mid-Atlantic
  • Staff model
  • Carve-out 10% of pharmacy benefit; remainder is managed internally