Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Utilization Management Practices


  • Some of the possible rationales discussed by the panel that plans use to justify differential management include the following: utilization above national benchmarks, costly relative to commonly used alternative services or levels of care; unexplained practice variation in the use of services or levels of care; unexplained rising cost trend (e.g., Suboxone), evidence of inconsistent adherence to established practice guidelines, identified gaps in care (e.g., low rates of post-hospital follow-up care); and possible experimental or investigational procedures (e.g., rapid opiate detox).

  • Some panelists suggested that, especially in substance abuse treatment, the potential high variation in practice (in treatments received for those with similar substance abuse problems) that is not solely determined by provider training or qualifications suggests that differential management may be appropriate.

  • Differential concurrent review may be appropriate when you have a provider type that is not licensed by the state -- this should be the same across the behavioral health and general medical benefit -- although the effect will be felt more on substance abuse providers.

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