ABSTRACT
Health maintenance organizations (HMOs) are prepaid health insurance plans characterized by their emphasis on voluntary enrollment, preventive care, and integration of services. Unlike other health insurances whose reimbursement mechanism favors hospitalization, the cost incentive in HMOs favors greater utilization of outpatient services. In planning a mental health service in an HMO, one must consider the nature of the enrolled population, the delivery model, access to services, the nature of services to be provided, staffing, and the ongoing monitoring of those services. In an effort to provide ready access to emergency psychiatric services, the mental health department at Harvard Community Health Plan developed a crisis team to centralize emergency mental health services. The members of the crisis team are responsible for the initial contact with psychiatric emergencies referred by primary care, for initial evaluation and treatment, and for disposition and follow-up.
