Contract would trim health-care costs

September 09, 1992|By Suzanne Wooton | Suzanne Wooton,Annapolis Bureau

ANNAPOLIS -- In an effort to curb health-care costs, Maryland officials are poised to award a contract that would allow one company to screen all state employees seeking mental health or substance abuse care.

State officials say their plan would save at least $3 million just in administrative costs by paying one firm to provide services now offered by 13. And they say it would produce further savings by discouraging unnecessary treatment -- even though the plan would actually expand coverage for many state workers.

But critics charge the plan would merely deny care needed by employees and their families.

Currently, mental health and substance abuse benefits are included in state employees' overall health insurance package. Workers can choose a "preferred provider plan" that offers a full range of mental health services, or a health maintenance organization that offers much less. About 40 percent of all state workers are insured by an HMO.

The proposed new contract -- which goes to the state Board of Public Works for approval Sept. 23 -- would provide the same coverage for all employees at the level of benefits now provided in the preferred provider option, the state's best plan.

"Everybody will get an equal quality of service under a managed system of care," Hilda E. Ford, secretary of the Department of Personnel, said at a hearing in Annapolis yesterday. "You won't have some getting Cadillac services and other people getting nothing."

The savings would be realized mainly through a "gatekeeper" approach, in which one company would decide who gets care and what kind. Any employee who wanted substance abuse or mental health care would be required to call an 800 number. A counselor would assess the caller's condition and, if it were serious enough, refer him to a crisis intervention center associated with the company.

Otherwise, the counselor would set up an appointment where the employee would get a list of health-care providers whom he could see. If an employee wanted to select his own doctor, then the state would pay limited benefits.

Currently, managed care or utilization review is applied to most areas of surgical and medical coverage for state workers. But many fear that determining mental health needs is far more subjective.

"Because of the pressure to save money, inexperienced people will be making arbitrary decisions," said William Bolander, an official with the American Federation of State, County and Municipal Employees.

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