Employer-Based Innovations in Behavioral Health Benefits

Since the early 1980s, employers have been developing processes to more effectively manage their behavioral health care expenditures. Initially, employers focused their cost-containment efforts on inpatient admissions or substance abuse rehabilitations. Over time, employers realized that finding a solution with the greatest impact entailed a more comprehensive approach to the problem. They developed cost-containment strategies to the employer carve-out, an all-encompassing managed care approach focused on psychiatric and substance abuse conditions. The results of employer-initiated carve-outs have been dramatic. If passed, President Clinton's health care bill would have discouraged employer incentives for similar innovations and would haved ended this chapter in health care when the programs developed on behalf of employers achieved marked improvement in controlling health care costs.