The study methodology consisted of telephone interviews with a wide range of stakeholders and a comprehensive literature review. The interviews, held with consumer advocates, health care providers and provider associations, managed care firms, and a few experts in the field, were conducted from October 2001 through May 2002 and generally lasted about 30 minutes. Respondents were asked about the current practice of information sharing between providers and payers, why the information is collected, how it is used, and their views on what information should be shared. Respondents were also asked to identify any models for privacy-sensitive approaches to managing care. We also asked providers and managed care firms if they could provide us with copies of forms and telephone protocols used in utilization management and if they could provide us with the contract language that authorizes them to access patient charts for audits and quality management. Table I.1 lists the number of respondents by type.
The comprehensive literature review (see Appendix A) was designed to document relevant information from the past five years on how managed care payers collect personal health information about consumers of mental health and substance abuse services. Our objective was to develop an understanding of why managed care firms collect personal health information, what types of information are collected, what problems or concerns have been raised by stakeholders, and what models and solutions have been proposed by experts in the field.
We found a great deal of information on why managed care firms collect personal health information and the different ways in which they use this information. We also found a great deal of information on the problems that have been encountered, particularly provider and patient reluctance to share information disclosed in a privileged therapist-patient relationship. We found relatively little literature on the specific information typically requested by managed care firms in order to authorize services. In searching for solutions and models, we found a few sources that made specific recommendations as to what information should be disclosed to the managed care firm, but the prevailing documentation involved recommendations by experts on how to maintain the confidentiality of sensitive information once it is in the possession of an MCO. The next chapter more fully explores current practices of MCOs in the collection of patient health information.
|Type of Respondent||Number|
|Mental health/substance abuse providersa||12|
|Managed care organizations|
|Managed behavioral health organizations (MBHOs)||3|
|Health maintenance organizations (HMOs)||2|
|Mental health consumer advocates||4|
|Substance abuse consumer advocates||2|
|Experts in the field|
Note: At the outset of the study, we planned to conduct interviews with managed care associations and accrediting organizations. When we contacted these organizations, they did not have staff who were knowledgeable and able to discuss these issues, so we substituted additional interviews with MCOs and providers.
aMost respondents at provider associations were also providers themselves, so these are reflected in both categories
"MHPrivacy.pdf" (pdf, 768.25Kb)
"appen-b.pdf" (pdf, 224.4Kb)