how does commercial health insurance cover

Commercial Health Insurance Coverage of Preventive Behavioral and

Developmental Health Services

By

Michael C. Barth and Kathryn Taaffe McLearn

National Program Director

Healthy Steps for Young Children Program

Senior Fellow and Research Scientist

The National Center for Children in Poverty

ICF International mbarth@icfi.com

KM2058@columbia.edu

212-304-7194

July 18, 2002

HSHI Survey Report_7.18.02

COMMERCIAL HEALTH INSURANCE COVERAGE OF

PREVENTIVE BEHAVIORAL AND DEVELOPMENTAL HEALTH SERVICES

I. INTRODUCTION

The Surgeon General’s Report on Health Promotion and Disease Prevention released in 1979, and the Select Panel for the Promotion of Child Health report that followed two years later initiated a revolution in the fields of public and child health (U.S. Public Health Service 1979;

U.S. Department of Health and Human Services 1981; Budetti and Feinson 1993). These reports highlighted the need for comprehensive health services that could include not only traditional medical care, but also counseling, anticipatory guidance, and various health promotion and preventive information and education activities that could be oriented to psychosocial issues.

Since then, major child health supervision guidelines, such as those released by the American

Academy of Pediatrics (AAP 1997) and Bright Futures (Green 1994; Green and Palfrey 2000), have attempted to respond to the understanding of the often called “new morbidities” (Haggerty,

Rothman, and Pless 1993) and emphasize the importance of prevention, early detection, and management of various behavioral, developmental and social functioning problems encountered in routine pediatric practice as part of accepted medical necessity standards for pediatric practice

(Cheng and others 1999, AAP 1997; Green 1994; Green and Palfrey 2000).

In addition, evidence from national studies of access to and utilization of health services indicates that, regardless of family income, parents want and need information on the psychosocial, behavioral, and developmental aspects of their young children’s health (Young,

Davis, Schoen, and Parker 1998; Halfon, McLearn, and Schuster 2002). Unfortunately,

HSHI Survey Report_7.10.02 1

clinicians face significant barriers to providing the range of conversation, questioning, examination, and formal screening that is indicated by these studies (Halfon et al. 2002).

According to a recent AAP survey of a random sample of 794 members who provide primary care (AAP 2000), 94 percent thought they should ask about a child’s development while

80 percent felt confident that they could competently advise parents (hardly an overwhelming feeling of self-confidence). At the same time, respondents identified lack of time (80 percent), inadequate reimbursement (55 percent) and lack of non-physician staff to perform the developmental assessments (as summarized in Halfon et. al.2002). Inadequate time and inadequate reimbursement (which often amount to the same thing) are two barriers that discourage the provision of the comprehensive preventive behavioral and developmental health services.

Coverage for these types of primary care services are limited by health insurance company policies: the health insurance community has not adequately adjusted to the new science of prevention and health promotion and is still overwhelmingly based on a disease model of health care. One national survey of commercial insurers (Fox and McManus, 2001) revealed that the over 80 percent of the plans had contract language to limit the scope of covered child health services to those specific to treatment for illness and injuries and disabilities with many exclusions for treatment of developmental, learning and mental health problems; only 4 percent of the commercial insurers had specific contract language for preventive services.

For insurers that do cover preventive health services, surveys of commercial health plans indicate that insurance for preventive services is erratic, subject to frequent changes, and contains internal inconsistencies in reimbursement policies (Starfield and Vivier 1995;

Merenstein, Rabinowitz, and Louis 1999). Managed care plans appear to offer more comprehensive health promotion and preventive services than other types of health plans and are


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more likely to rely on a more comprehensive set of health education approaches to communicate health information (MMWR, 1995; Schauffler & Chapman, 1998).

Commercial/private insurance programs provide health care coverage for a significant proportion—42 percent or 3.8 million—of the 8.8 million insured children in the United States

(Fronstin 2000). Thus, the implications of insurer coverage policies and practices on clinicians and the services they provide are important to understand in order to improve health care for young children and their families. The studies on the critical value of health promotion and preventive health services have pointed the way to new opportunities for a broader range of services to be incorporated into routine pediatric primary care. Comprehensive health coverage insurance can be used to support and foster preventive behavioral and developmental child health services by enabling pediatric clinicians to incorporate these elements into their practices.

Without adequate reimbursement, providers will not be able to offer these preventive services and parents will be discouraged from or unable to use them (Rosenbaum 1993; Rosenbaum, et. al. 2001).

Here, we report on a case study that examined the extent to which the coverage policies of commercial/private employer-based health insurance plans reflect the emerging standards of preventive pediatric practice that stresses early childhood development and preventive care. We undertook a telephone survey of a subset of health insurers to ask for which developmental and behavioral services they reimburse and what would convince them to liberalize reimbursement.

II. METHODOLOGY

Sample

A case study methodology was employed to question commercial health insurers about coverage and reimbursement for preventive behavioral and developmental health services for young


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children. Medical directors of insurers that were prominent in communities containing Healthy

Steps program sites were contacted. Healthy Steps is an expanded approach to pediatric primary care that includes a set of preventive and child development services and information for parents with very young children (See Table 1). The essence of the Healthy Steps for Young Children

Program is to add to a pediatric practice a new developmental specialist to the clinical team.

Healthy Steps sites include private practices, clinics, health maintenance organizations, and academic medical centers.

We proceeded as follows. First, Healthy Steps sites were asked to identify the three largest commercial health insurers from which they receive reimbursement. Duplicates caused by the existence of statewide companies in states containing multiple Healthy Steps sites were eliminated. Thirty-eight potential interviews remained. A combination of telephone calls, email, and mail to contact the medical directors of each plan was employed. Ultimately, the completed sample included 16 respondents for a response rate of 42 percent. Of the 16, 15 offered fee-for-service plans and six offered capitated plans (i.e., 10 companies offered both).

Non-participation was caused by a combination of explicit company policies not to participate in such surveys and an apparent lack of interest on the parts of the medical directors (“too busy”).

Potential respondents were told that their responses would be confidential as would the name of the company, that the interview would take 12-15 minutes, that they could do the interview by telephone or complete an electronic or paper questionnaire.


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While the sample is small and statistically non-representative,

1

it includes a decent representation of large insurers and is in our judgment substantively representative of the insurers that provide commercial health insurance to individuals and families who receive their primary pediatric care at Healthy Steps sites. Moreover, based on the answering patterns over time, we believe that further data points would very likely leave the central tendency of the responses unchanged while perhaps increasing the range. That is, as additional interviews were completed, the means of the responses varied very little.

Questionnaire

A questionnaire was developed based on the developmental services typology developed by

Regalado and Halfon (2001). The typology includes four major categories: Assessment,

Education, Intervention and Care Coordination with eleven specific clinical activities or services clustered within the four categories (See Table 2). The four categories of developmental services and 11 related clinical activities were based on the professional clinical guidelines of the

American Academy of Pediatrics Health Supervision Guidelines (AAP, 1997) and the Maternal and Child Health Bright Futures (Green, 1994) initiative for developmental surveillance. In our telephone survey, the respondent was asked if the health insurer reimbursed each of two sets of providers: physicians/nurse practitioners and registered nurses/licensed clinical social workers/other for each of the 11 types of preventive and developmental services. We then asked the following question: “If the answers to the question about behavioral and developmental services reimbursement are not ‘Yes,’ please indicate what representations, evidence, etc., would be necessary to alter the company’s policy to provide reimbursement for preventive health services related to child behavior and development?” The purpose of this question was to elicit information on what it would take for the insurer to change policy and add coverage.

1 Across the sample, the mean number of lives covered by the respondent companies is 4.2 million (sd = 6.2 million) for the fee-for-service plans and 3.7 million (sd = 3.6 million) for capitated plans.


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III. RESULTS

Tables 3 through 6 provide the responses to the central question of the study: Do commercial health insurers reimburse for behavioral and developmental services? The results for fee-forservices and capitated plans are reported separately.

Fee–for-Services Plans. Looking first at reimbursement patterns of physicians and Pediatric

Nurse Practitioners at the 15 fee-for service plans, across the four categories and 11 services, there is a wide range for the number of companies that reimburse for developmental services

(See Table 3.) The highest rate of reimbursement is for Office Counseling, reimbursed by 12 of

15 respondent companies (80 percent). While in an absolute, context-free sense, 80 percent may seem a large incidence, it implies that pediatricians of families insured by one-fifth of companies cannot gain reimbursement for counseling that may be needed during an office visit.

More striking in this regard is that four of 15 fee-for-services plans (27 percent) do not reimburse for Developmental Screening, an important element of recommended health supervision guidelines (see AAP 1997; Green, 1994). The same is true for Anticipatory Guidance, thought by leading pediatricians to be a highly effective way to educate mothers and fathers about their children (Zuckerman and Parker 1995).

Developmental services such as Distribution of Written Materials, Care Coordination, and

Telephone Advice rarely give rise to reimbursement; therefore, providers must conduct these activities at their own expense. A final point puts this information in a rather more negative perspective than the data themselves. Several respondents added to their affirmative answers the condition that “the service is considered part of a regular well child visit” or words to that effect.


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The essence of the condition would appear to be that if the provider can offer the service within a regular visit it is covered, but only in that case.

In aggregating the data to determine how many fee-for-service plans covered a comprehensive set of developmental services, we found that none of the respondent companies reported reimbursing physicians or pediatric nurse practitioners to provide all 11or 10 of the listed developmental services; two of the companies did not reimburse for any of the 11 developmental services (See Table 4). Less than half (46 percent) of the respondents reported that the plan covered physicians or nurse practitioners to provide six of the eleven services. All seven plans that covered six services covered the same six preventive and developmental services: developmental screening, family psychosocial risk screening, anticipatory guidance, office counseling, home visits and family and/or individual psychotherapy. Two-thirds, or 10 out of the 15 fee for service plans, reimbursed physicians for three clinical developmental service activities: developmental screening, anticipatory guidance and office counseling. The developmental services that are usually not covered by fee for service plans are telephone advice line, case management, written materials, referrals, and parent education.

We asked about reimbursement of Registered Nurses (RNs) and Licensed Clinical Social

Workers (LCSWs) in fee for service plans because persons with these sets of skills and experience are natural extenders of or substitutes for physicians and PNPs in the provision of developmental services. The data in Table 3 offer a clear message: these extenders may extend, but their services will not be reimbursed. Across the 15 companies and 11 services, less than 5 percent receive reimbursement.


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Capitated Plans. The reimbursement patterns for physicians and nurse practitioners in the six capitated plans reveal that all (100 percent) of the plans cover the provision of four developmental services: developmental screening, family psychosocial risk screening, anticipatory guidance and office counseling (See Table 5). Five out of the six, or 83 percent, of the capitated plans reimburse physicians and nurse practitioners to provide home visits and family or individual psychotherapy. As indicted in Table 5, only one plan covers the distribution of written materials and none of the six capitated plans cover the provision of a child development telephone advice line or parent education services.

In aggregating the data for the capitated plans, we found the none of the six plans reimbursed physicians and nurse practitioners to provide nine, ten or all eleven of the listed developmental services (See Table 6). However, we did find that five of the six plans did reimburse physicians and nurse practitioners to provide coverage for the following set of six developmental services: developmental screening, family psychosocial risk screening, anticipatory guidance, office counseling, home visits and family and/or individual psychotherapy. These five capitated plans did not reimburse physicians or nurse practitioners to provide the following five developmental services to their patients and families: parent education, distribution of written materials, telephone advise line, case management and referrals for developmental problems.

In asking about reimbursement of registered nurses and licensed clinical social workers for provision of preventive and developmental services, we found that capitated plans would only reimburse registered nurses and licensed clinical social workers for three types of services and each of these by only one or two of the six capitated plans (See Table 5): parent education, family or individual therapy, and case management.


8

What might change this picture for both fee-for-service and capitated plans? Table 7 reports the responses to the question reproduced above regarding what it would take to change company policy. Of the 15 fee-for-service survey respondents, eight responded to this question. Since multiple responses were permissible, 16 such are reported for fee for service plans; for the six capitated plans, only two medical directors responded. The medical director-respondents in both fee for service and capitated plans stated that outcomes data and evidence on cost and costeffectiveness would be most likely to cause the company to change policy to reimburse the services they currently do not.

IV. DISCUSSION

Acknowledging the considerable limitations and non-generalizability of the data from this small case study sample, the responses from the medical directors of commercial insurers present an informative snapshot of the current reimbursement patterns for developmental services as part of pediatric primary care.

The fifteen fee-for-service insurance plans examined in this study provided quite limited reimbursement for developmental services provided by physicians and nurse practitioners. Two of the fifteen did not reimburse for any of the services surveyed in this study. Among plans that did cover some developmental and preventive services, the reimbursement policies for which services were covered differed greatly. However, many insurance companies reimbursed clusters of specific services. Two-thirds of all the fee-for-service plans covered developmental screening, anticipatory guidance, and office counseling. See Table 8. In addition, of the seven fee-for-service plans that reimbursed for six or more services, all seven reimbursed for the two


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services in the Assessment category—developmental screening and family psychosocial risk screening; anticipatory guidance in the Education category; and three services in the Intervention category—office counseling, home visits, and family and/or individual counseling. This concordance among the plans for the services covered indicates an incorporation of select elements of the preventive pediatric primary care guidelines into insurance company policies.

Overall, office counseling was reimbursed by the most numbers of commercial fee for service plans. The services least likely to be reimbursed were parent education; distribution of written materials, books, and videos; telephone advice lines; case management for diagnosed developmental problems; and referral for behavioral and developmental problems to community resources. It is notable that the only insurance companies with fee for service plans that reimbursed for either of the Care Coordination services (case management and referral) were the three companies that covered the most number of services.

Our sample of six capitated health insurance plans is two small to draw a generalized comparison between capitated and fee-for-service plans, but the results indicate a similar pattern to the one found in other studies, namely that capitated health insurance plans are more likely to include prevention and developmental services than fee-for-service plans (MMWR 1995; Schauffler and

Chapman 1998; Shiels and Wolfe 1992). The commercial capitated plans in this survey appear to reimburse doctors and nurse practitioners for a more comprehensive set of developmental and preventive services in the four categories than fee-for-service plans. All six plans cover 4 developmental services provided by physicians and nurse practitioners: developmental and family screening, anticipatory guidance, and office counseling and all but one insurance company also reimburses for home visits and family or individual psychotherapy. Five of the six companies reimburse for the two services in the Assessment category (developmental screening


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and family psychosocial risk screening); three of the four services in the Intervention category

(office counseling, home visits and family and or individual therapy), and for anticipatory guidance in the Education category. Overall, the six capitated plans in our study reimburse for more preventive child development services than the fifteen fee-for-service plans we surveyed.

Consistent with the findings of reimbursement policies for fee-for-service plans, care coordination services were amongst those services least likely to be reimbursed, along with distribution of written materials. Parent education and telephone advice lines as provided by physicians and nurse practitioners were not reimbursed by any of the capitated insurance plans, which is also similar to the practices of fee-for-service insurance plans surveyed in this study.

However, the capitated plans surveyed were more likely to cover home visits and psychotherapy than the fee-for-service plans surveyed.

It is also quite noteworthy that results from both the fee-for-service and capitated plan surveys reveal that neither type of commercial insurer has policies that consistently reimburse licensed health professionals other than physicians and nurse practitioners from providing specific preventive developmental services. This narrow definition the type of health professional eligible for reimbursement for providing developmental services goes contrary to current studies about how to best restructure the health system to enhance the delivery of care to all patients.

For example, the recent Institute of Medicine report, Crossing the Quality Chasm (IOM 2000) , explicated the need for pediatric clinicians to work with non-physician health professions, such as the RNs and LCSWs incorporated in the Healthy Steps model of care, in order to improve the quality of care provided to patients. The CHASM study pointed to the advantages that high performing patient-centered teams can produce towards aims of preventive medicine, health promotion, and coordination of care, but the report warns that a supportive payment and


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regulatory environment is necessary to influence provider and patient behavior and calls on all insurance companies to reexamine their reimbursement and coverage policies to remove barriers that impede quality improvement. In the policies of the insurance companies surveyed in this study, however, non-physician, non-nurse practitioner provider reimbursement severely lags behind reimbursement for MDs and PNPs. These companies are missing the opportunity to support and enhance preventive developmental health services for children by remaining within the bounds of the more traditional medical model of who treats patients and refusing to reimburse pediatric care that is provided by RNs and LCSWs.

Medical Directors of insurance companies interviewed in this study report that the information that would encourage them to change reimbursement policies is, most often, clinical outcomes and cost effectiveness data. This was consistent among capitated and fee-for-services plans.

“Outcomes-based medicine” is, in fact, believed to contribute to increased quality of health care.

However, in today’s competitive health care market, few policies are adopted that cannot pass a rigorous economic hurdle. This hurdle is typically difficult for preventive programs whose benefits may become measurable (and monetizable) only over fairly long periods of time

(Karoly, et al 1998). It is challenging to measure short-term outcomes on prevention and health promotion—especially for an area of health as complex as behavior and development.

Therefore, problems remain in relying on outcomes evidence and the interrelated medical necessity requirements for these types of pediatric preventive services (Fox and McManus 2001;

Dalzell 2001).

The past twenty years have seen the development of a set of prescriptive guidelines that offer a foundation for preventive pediatric primary care practices as evidenced by the national reports on


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child health and professional health supervision guidelines. We see that there has been some progress in the coverage for preventive and developmental pediatric services, and most insurance companies reimburse for some services, especially among the capitated plans. Unfortunately, there is a significant gap between a broad recognition of reimbursing for services that address the child and family psychosocial issues in promoting child health and what commercial insurance companies are willing to incorporate into their reimbursement policies and which health professional is able to bill for providing the service. The discrepancies revealed in this study between practice guidelines and insurance policies for reimbursement of pediatric developmental and preventive services indicate the degree to which commercial health insurance companies are missing opportunities to promote and enhance child health and development.


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Table 1.

HEALTHY STEPS COMPONENTS



Enhanced well child care through well child office appointments to answer parents’ questions about child development, identify family health risks, and take advantage of “teachable moments.”



Home visits by Healthy Steps Specialists at key developmental points.



Child development telephone information line staffed by Healthy

Steps Specialists.



A series of child development and family health checkups with developmental screens to detect signs of developmental or behavioral problems, identify family health risks, and provide teachable moments.



Written informational materials for parents that emphasize prevention, including bulletins sent out before well-child visit and handouts on a variety of issues..



Parent groups to offer social support as well as interactive learning opportunities.



Linkages to community resources and parent-to-parent connections.



Services of Healthy Steps Specialists who work with the Primary

Care Clinicians, nurses, and receptionists in the practice to form a

Healthy Steps team, all of whom work with families to promote nurturing, positive relationships between parents and children and between parents and the practice.


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Table 2.

PREVENTIVE BEHAVIORAL AND DEVELOPMENTAL HEALTH SERVICES

ASSESSMENT

Developmental Screening

Family Psychosocial Risk Screening

EDUCATION

Anticipatory Guidance

Parent Education (e.g. Parenting Classes)

Distribution of Written Materials, Books, Videos

PROBLEM-FOCUSED INTERVENTION

Office Counseling

Telephone Advice Line

Home Visits

Family and/or Individual Psychotherapy

CARE COORDINATION

Case Management for Diagnosed Developmental Problems

Referral to Community Resources for Behavioral and Developmental Problems

Source: Regalado and Halfon (2001).


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Table 3.

COMMERCIAL HEALTH INSURER REIMBURSEMENT FOR BEHAVIORAL AND DEVELOPMENTAL SERVICES IN

FEE-FOR-SERVICE PLANS (Sample = 15)

1. ASSESSMENT a. Developmental Screening b. Family Psyhosocial Risk Screening

2. EDUCATION c. Anticipatory Guidance d. Parent Education (e.g., Parenting Classes) e. Distribution of Written Materials, Books, Videos

3. PROBLEM-FOCUSED INTERVENTION f. Office Counseling g. Telephone Advice Line h. Home Visits i. Family and/or Individual Psychotherapy

4. CARE COORDINATION j. Case Management for Diagnosed Developmental Problems k. Referral for Behavioral and Developmental Problems to Community

Resources

Source: Healthy Steps Program Office Telephone Survey of Commercial Health Insurers.

Companies that

Reimburse for

Companies that

Reimburse for

Physician/PNP

% (N)

LCSW/RN

% (N)

73% (11)

67% (10)

0% (0)

0% (0)

73% (11)

20% (3)

13% (2)

0% (0)

7% (1)

0% (0)

80% (12)

7% (1)

60% (9)

53% (8)

13% (2)

20% (3)

13% (2)

0% (0)

13%(2)

20% (3)

0% (0)

0% (0)


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Table 4.

AGGREGATED DEVELOPMENTAL SERVICES REIMBURSED BY

FEE-FOR-SERVICE PLANS

11 Services

10 Services

9 Services

8 Services

7 Services

6 Services

Cumulative

Number of

Insurers

Reimbursing Reimbursing for At Least

This Number This Number of Services

0

0

2

4

4

7

Number of

Insurers for Exactly of Services

Services Covered by

Insurers Reimbursing for

Exactly This Number of

Services

0

0

2

A, B, C, D, E, F, H, I, K

A, B, C, D, F, H, I, J, K

A, B, C, F, H, I, J, K

2 A, B, C, D, E, F, H, I

0

A, B, C, F, H, I

A, B, C, F, H, I

3 A, B, C, F, H, I

5 Services

4 Services

3 Services

2 Services

1 Service

0 Services

8

9

12

13

13

15

1 A, B, C, F, H

1 A, B, C, F

A, B, C

F, G, I

3 A, C, F

1 F, H

0

0

Key:

A=Developmental Screening

B=Family Psychosocial Risk Screening

C=Anticipatory Guidance

D=Parent Education

E=Distribution of Written Material, Books, Videos

F=Office Counseling

G=Telephone Advice Line

H=Home Visits

I=Family and/or Individual Psychotherapy

J= Case Management for Diagnosed Developmental Problems

K=Referral for Behavioral and Developmental Problems to Community Resources



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Table 5.

COMMERCIAL HEALTH INSURER REIMBURSEMENT FOR BEHAVIORAL AND DEVELOPMENTAL SERVICES IN

CAPTITATED PLANS (Sample = 6)

1. ASSESSMENT a. Developmental Screening b. Family Psychosocial Risk Screening

2. EDUCATION c. Anticipatory Guidance d. Parent Education (e.g., Parenting Classes) e. Distribution of Written Materials, Books, Videos

3. PROBLEM-FOCUSED INTERVENTION f. Office Counseling g. Telephone Advice Line h. Home Visits i. Family and/or Individual Psychotherapy

4. CARE COORDINATION j. Case Management for Diagnosed Developmental Problems k. Referral for Behavioral and Developmental Problems to Community

Resources


Companies that

Reimburse for

Companies that

Reimburse for

Physician/PNP

% (N)

LCSW/RN

% (N)

100% (6)

100% (6)

0% (0)

0% (0)

100% (6)

0% (0)

17% (1)

0% (0)

83% (5)

83% (5)

83% (5)

33% (2)

33% (2)

0% (0)

17% (1)

0% (0)

0% (0)

0% (0)

0% (0)

33% (2)

17% (1)

0% (0)


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Table 6.

AGGREGATED DEVELOPMENTAL SERVICES REIMBURSED BY

CAPITATED PLANS

Cumulative

Number of

Insurers

Number of

Insurers

Reimbursing Reimbursing Services Covered by for At Least for Exactly Insurers Reimbursing for

This Number This Number Exactly This Number of of Services of Services Services

11 Services

10 Services

9 Services

8 Services

7 Services

6 Services

5 Services

4 Services

3 Services

2 Services

1 Service

0 Services

0

0

0

2

2

5

6

6

6

6

6

6

0

0

0

2

A, B, C, F, H, I, J, K

A, B, C, F, H, I, J, K

0

A, B, C, F, H, I

A, B, C, F, H, I

3 A, B, C, F, H, I

1 A, B, C, E, F

0

0

0

0

0

Key:

A=Developmental Screening

B=Family Psychosocial Risk Screening

C=Anticipatory Guidance

D=Parent Education

E=Distribution of Written Material, Books, Videos

F=Office Counseling

G=Telephone Advice Line

H=Home Visits

I=Family and/or Individual Psychotherapy

J= Case Management for Diagnosed Developmental Problems

K=Referral for Behavioral and Developmental Problems to Community Resources



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Table 7.

FEE-FOR SERVICE * AND CAPITATED

†

INSURERS CRITERIA FOR CHANGING REIMBURSEMENT POLICIES

Question: If you do not reimburse for these services, please indicate what representations, evidence, etc., would be necessary to alter the company's policy to provide reimbursement for preventive health services related to child behavior and development?

Category

Outcomes Data

Evidence on Cost

Evidence on Cost Effectiveness

State Law Mandating Services

Marketplace Demand

Support from National Medical Organization

What Competitors are Doing

Percent of participants providing a response (frequency of response)

Fee-For-Service Plans

38% (3)

38% (3)

38% (3)

25% (2)

25% (2)

13% (1)

13% (1)

Productivity to Employer

Effect on Medical Utilization

0% (0)

0% (0)


Note: *There were 8 respondents to this question for fee-for-service plans.



There were 2 respondents to this question for capitated plans.

Capitated Plans

100% (2)

50% (1)

50% (1)

0% (0)

0% (0)

0% (0)

0% (0)

0% (0)

0% (0)


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Table 8

REIMBURSEMENT OF GROUPS OF SERVICES BY FEE-FOR-SERVICE AND

CAPITATED PLANS

Services That Are Commonly Grouped

Together

Number of Fee-

For-Service Plans that Reimburse for All Services in

Number of

Capitated Plans that Reimburse for

All Services in

Group Group



Office Counseling 10 6




Office Counseling 9 6




Office Counseling

Home Visits 8 5




Office Counseling

Home Visits

Family and/or Individual Psychotherapy 7 5



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