Privacy Issues in Mental Health and Substance Abuse Treatment: Information Sharing Between Providers and Managed Care Organizations: Final Report. I. Introduction

01/17/2003

Confidentiality is a key element of mental health and substance abuse treatment.  In the course of therapy, clients reveal personal, highly sensitive information that they may not reveal to anyone else.  Clients trust that this information will be kept confidential by the clinician/therapist.  In affirming what is known as psychotherapist-patient privilege, the United States Supreme Court (Jaffe v. Redmond, 518 U.S.1 (1996)), stated not only that it is in the public interest to allow patients to access effective mental health and substance abuse treatment but also that effective psychotherapydepends upon an atmosphere of confidence and trust in which the patient is willing to make a frank and complete disclosure of facts, emotions, memories, and fears.  In the absence of this assurance of confidentiality, many individuals with mental and emotional disorders might refuse or fail to seek treatment, going without needed services.

As the payer for this treatment, however, a third-party insurer, such as a managed care organization (MCO) or insurance company, has a right to know what the services are for which payment is being requested and whether the treatment is appropriate.  Before paying the claim, therefore, the payer requests some personal health information, such as the patient's presenting problem, health status, and/or treatment planned or received.  The amount of personal health information required to pay claims varies by payer; some require only basic information, such as the patient's diagnosis and services received, while others require more detailed information on the patient's symptoms and specific treatment goals and outcomes.  The dual, but opposing, needs for confidentiality and disclosure have created tension between providers and payers of services. 

In this report, we begin in this chapter by explaining the "minimum necessary principle" that is the topic of the study, and reviewing the purpose of the study, the relationship between managed care and privacy, the legal and regulatory context for the transfer of patient information, and the study methodology.  The chapters that follow discuss current practices of MCOs in the collection of patient health information, including why the information is collected and what information is commonly sought, variation among plans in these two areas, and the methods for collecting information.  Also discussed are stakeholder views on the information collected and models that have been proposed for standardizing and minimizing the information routinely shared with third-party payers.  The paper concludes with some possible “next steps” to encourage more privacy-sensitive approaches to health plans’ requests for personal health information.

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