In a recent interview, he told Psychiatric News, "Integrated disease management is our future. There’s big momentum [in support of the concept]."
He said that this support comes from employers and employee benefits managers, who pushed the establishment of "carveouts" to provide and manage mental health services and now are realizing the limitations of that model.
Rodriguez pointed out that the National Committee for Quality Assurance (NCQA), a private, nonprofit organization that issues an annual report evaluating health care organizations on various measures, has added standards concerning integration of care to its evaluations of managed health care companies.
He was chair of the NCQA’s Behavioral Standards Subcommittee from its inception in 1996 until 2001.
In its September 2003 report, the NCQA flagged mental illness as an area in which the health care system "continues to struggle."
How can Magellan, which is itself a carveout company, promote integration of care?
Rodriguez believes that "more sophisticated data systems," such as that used by Magellan, will enable psychiatrists and health care professionals to better identify patients at risk for diseases that might not be readily apparent.
He said, "As Magellan clearly is the biggest company in the behavioral health care industry, our database is the most capable of supporting this effort."
Rodriguez also described a model in which primary care doctors receive training to enable them to identify patients who need referrals for mental health services. The program recently was rolled out in Georgia by Blue Cross/Blue Shield of Georgia and Magellan, with support from researchers at Duke University School of Medicine and the MacArthur Foundation.
"It’s a prototype that’s being evaluated," Rodriguez said. "If successful, we would expect to try to implement it in every state in which we do business."
He added, "If Darrel Regier [director of APA’s Office of Research] and others are right, costs for mental health services will go up, but they will be more than offset by a decrease in other medical costs."
Rodriguez plans to point out to employers who are reluctant to offer mental health benefits the costs associated with employee absenteeism or presenteeism that come from untreated mental illnesss.
He said he also will make a case to employers that there is greater accountability to employers for the quality and costs of mental health benefits than for most medical services.
"I would have no hesitation in going to any group of payers and saying that the mental health benefit is more accountable than the general medicine benefit."
Rodriguez plans to expand Magellan’s research efforts and hopes to establish a mental health research alliance with other organizations, such as APA.
According to the 2002 National Survey of Psychiatric Patients conducted by the American Psychiatric Institute for Research and Education’s Practice Research Network, 52 percent of responding psychiatrists are not on any managed care panels (Psychiatric News, March 19, 2003).
In the same article, Lawrence Lurie, M.D., chair of APA’s Committee on Managed Care, said, "Psychiatrists in managed care work with low fees, administrative hassles, and late claim payments."
Rodriguez responded to those data and concerns in a number of ways.
He submitted trend data, for example, that show an increasing number of psychiatrists on Magellan’s provider panels. In January 2002, Magellan contracted with approximately 42,000 providers of mental health services, of whom 6,881 were psychiatrists. In January 2004, the figures were 57,000 and 7,817, respectively, he said.
Rodriguez also offered trend data from Magellan’s annual provider-satisfaction survey. "Overall satisfaction" with Magellan increased from 81.6 percent in 2002 to 84.3 percent in 2003.
Satisfaction with accuracy of claims payments increased from 79.2 percent to 83.2 percent and with timeliness of claims payments from 73.9 percent to 78.6 percent.
The percentage of those who would accept a referral from Magellan (94.4) did not change between the two years.
Rodriguez mentioned changes on Magellan’s Web site that enable psychiatrists to request authorization for continued sessions for outpatient mental health or substance abuse treatment.
The redesigned site offers new features that allow practitioners to check member eligibility, the status of authorization requests and submitted claims, and credentialing or contracting status.
Rodriguez will meet with APA’s Managed Care Committee at the APA annual meeting in May.
Lurie said, "Some of the data were surprising. We will be interested in discussing various issues related to their collection and analysis with Dr. Rodriguez at that meeting." ▪