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Managed care cost-containment policies strengthen continuity of primary care for depressed patients

For depressed patients being treated in managed care settings, cost-containment strategies—such as high copayments or no coverage for mental health specialist visits—increase continuity of care with primary care providers (PCPs), according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS08349). Patients in this study were up to 18 percent more likely to remain with their PCPs if they had high copayments for specialty visits and no coverage for counseling visits.

Whether strengthening the alliance between patients and their PCPs is desirable will depend on the depression care patients receive, according to Lisa Meredith, Ph.D., of RAND. PCPs need to improve the care they provide for depression, which currently falls short of care guidelines, notes Dr. Meredith.

The researchers evaluated the effects of cost-containment strategies on continuity of care over a 2-year period among depressed patients at 46 managed care practices. Patients with no out-of-pocket costs for mental health visits were the least likely to remain with their PCPs, and patients with copayments from $11 to $20 per visit were the most likely to remain with their PCPs across the 2-year study period. Between 41 and 51 percent of patients were still with their PCPs at 24 months.

Patients with at least one mental health visit covered were twice as likely to change PCPs relative to those with no visits covered. Patients whose physicians received a bonus (usually for meeting volume goals, meaning less time per patient) were up to 11 percent more likely to remain with their PCPs over time than patients whose PCPs did not get bonuses. Also, uninsured patients and those on Medicare were most likely to stay with the same provider over time (20 percent more than those with Medicaid or private insurance.

See "Effects of cost-containment strategies within managed care on continuity of the relationship between patients with depression and their primary care providers," by Dr. Meredith, Roland Sturm, Ph.D., Patti Camp, M.S., and Kenneth B. Wells, M.D., M.P.H., in the October 2001 Medical Care 39(10), pp. 1075-1085.

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