Thursday, January 16, 2003

GHA drops mental health services

Insurance changes squeeze area's biggest doctor group

By Tim Bonfield
The Cincinnati Enquirer

Group Health Associates, Greater Cincinnati's largest multispecialty physician group, plans to discontinue providing mental health services in about three months.

The decision will affect several thousand patients who have been receiving treatment and counseling from three psychiatrists and about 25 other professionals, including psychologists, social workers and nurses.

Group Health Associates has been reorganizing itself because fewer health insurers are selling "capitated" managed care plans, which pay providers a set monthly fee based on the number of covered people served. Instead, more patients are covered by discounted fee-for-service plans that pay claims after service is provided.

The changing trend has affected cash flow for the group and, as a result, the group cannot afford to continue offering mental health services, which have started losing money, said Dr. Pat Tellez, chief executive of Group Health.

Earlier this week, the group told its behavioral health staff that they would be losing their jobs in the next two to three months.

Some or all of the staff might be able to merge with another mental health group, allowing patients to continue seeing their existing providers, but negotiations are not complete, Dr. Tellez said. If no deals can be made, patients would have to switch to other providers listed in their insurance plans.

"This is something that has been a very difficult decision for us," Dr. Tellez said. "Behavioral health has been one of the specialties we offered since we began (in 1974). But given the economic realities we are facing, we are unable to continue carrying out that mission."

Dr. Tellez said the group spends too much time and money fighting insurance plans over denied mental health coverage for the low reimbursements paid.

Group Health Associates includes about 100 doctors working in eight Tristate offices. Dropping mental health services is the second major change to be announced by the group in recent weeks.

Earlier this month, the group agreed to discontinue Paragon Health System, a joint venture between the doctors and Anthem Blue Cross and Blue Shield that oversaw managed care services to many local Anthem patients.

The group is not facing collapse, Dr. Tellez said.

"Overall, Group Health Associates is financially secure," he said.


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