ABSTRACT
Provider selection serves the function of utilization management in three major ways. First, network development limits the numbers of various types of services (e.g., inpatient beds) or providers (e.g., psychiatrists) to reduce pressure for increased utilization resulting from oversupply. Second, credentialling selects providers using criteria that include demonstrated capacity to manage utilization successfully (through providing historical data on average length of stay or average number of outpatient visits per treatment episode) and to work collaboratively with utilization reviewers. Third, profiling reviews providers’ current utilization patterns and uses that data both as corrective feedback and to influence referral patterns. Profiling may also incorporate client outcomes and satisfaction data. In some private networks, profiling results in a small fraction of “low utilization” providers receiving the bulk of outpatient referrals (Hymowitz and Pollock, 1995). Clearly this type of strategy must be used much more cautiously in public settings that serve persons with SPMI.
