Two‐Year Outcomes of Fee‐for‐Service and Capitated Medicaid Programs for People with Severe Mental Illness
Health Services ResearchPublished 1 April 2002Open access
Brian J. Cuffel, Joan R. Bloom, Neal Wallace, Jaclyn W. Hausman, Teh‐wei Hu
Citations45
SJR quartileQ1
SJR score1.80
SNIP1.37
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Medicaid capitation in Colorado does not appear to have negatively affected the outcomes of people with severe mental illness during the first 2 years of the program.
Abstract
OBJECTIVE: To examine the effects of two models of capitation on the clinical outcomes of Medicaid beneficiaries in the state of Colorado. DATA SOURCE: A large sample of adult, Medicaid beneficiaries with severe mental illness drawn from regions where capitation contracts were (1) awarded to local community mental health agencies (direct capitation), (2) awarded to a joint venture between local community mental health agencies and a large, private managed behavioral health organization, and (3) not awarded and care continued to be reimbursed on a fee-for-service basis. STUDY DESIGN: The three samples were compared on treatment outcomes assessed over 2 years (total n = 591). DATA COLLECTION METHODS: Study participants were interviewed by trained, clinical interviewers using a standardized protocol consisting of the GAF, BPRS, QOLI, and CAGE. PRINCIPAL FINDINGS: Outcomes were comparable across most outcome measures. When outcome diffrences were evident, they tended to favor the capitation samples. CONCLUSIONS: Medicaid capitation in Colorado does not appear to have negatively affected the outcomes of people with severe mental illness during the first 2 years of the program. Furthermore, the type of capitation model was unrelated to outcomes in this study.
Keywords
PsychologyEconomics, Econometrics and Finance
Archives of General PsychiatryThe Global Assessment Scale
4,952 Citations1976Jean Endicott
The relative simplicity, reliability, and validity of the GAS suggests that it would be useful in a wide variety of clinical and research settings.
JAMADetecting Alcoholism
2,957 Citations1984John A. Ewing
Four clinical interview questions, the CAGE questions, have proved useful in helping to make a diagnosis of alcoholism and their use in clinical and research studies is described.
American Journal of PsychiatryRevising axis V for DSM-IV: a review of measures of social functioning
1,406 Citations1992
Evaluation and Program PlanningA quality of life interview for the chronically mentally ill
1,085 Citations1988Anthony F. Lehman
The development and psychometric evaluation of a structured, 45-minute Quality of Life Interview for the chronically mentally ill is described, which has satisfactory reliability and validity.
Archives of General PsychiatrySome Conceptual and Statistical Issues in Analysis of Longitudinal Psychiatric Data
728 Citations1993Robert D. Gibbons
A family of statistical models termed random regression models were used that provide a more realistic approach to analysis of longitudinal psychiatric data and indicated that both person-specific effects and serial correlation play major roles in the longitudinal psychiatric response process.
Archives of General PsychiatryThe Well-being of Chronic Mental Patients
602 Citations1983Anthony F. Lehman
Adding patients' subjective QOL evaluations doubled the explanatory power of a model based only on personal characteristics and objective life conditions, and global well-being was most consistently associated with personal safety, social relations, finances, leisure, and health care variables.
Health AffairsMental Health/Substance Abuse Treatment in Managed Care: the Massachusetts Medicaid Experience
223 Citations1995James J. Callahan, Donald S. Shepard +3 more
Over a one-year period, expenditures were reduced by 22 percent below predicted levels without managed care, without any overall reduction in access or relative quality, and the applicability of such a program to high-risk populations is supported.
Psychiatric ServicesSavings from a Medicaid carve-out for mental health and substance abuse services in Massachusetts
106 Citations1997Richard G. Frank, Thomas G. McGuire
The authors label this behavior "managing to the contract" and discuss some reasons why a managed care organization might behave in this way and the implications this behavior has for contract design.
JAMATennessee's Failed Managed Care Program for Mental Health and Substance Abuse Services
96 Citations1998Cyril F. Chang
It is pointed out that the TennCare Partners program's difficulties stemmed directly from a flawed design that spread funds previously earmarked for severely mentally ill patients across the entire Medicaid population.
Archives of General PsychiatryManaging the Care of Schizophrenia
92 Citations1996Barbara Dickey
Although per-person expenditures dropped and most patient patterns of care remained the same, longer-term study is recommended to asses whether the trends can be maintained.
JAMADoes Capitation Affect the Health of the Chronically Mentally III?
92 Citations1992Nicole Lurie
There was no consistent evidence of harmful effects of enrolling chronically mentally ill Medicaid clients in prepaid care, at least in the short run, and the generalizability of these findings may be limited to plans that control utilization by methods similar to those used in this study setting.
Health AffairsUtah's Prepaid Mental Health Plan: the First Year
73 Citations1995Jon B. Christianson, Willard G. Manning +5 more
The results of the analysis suggest that the UPMHP reduced admissions for inpatient mental health treatment, inpatientmental health expenditures, and total mental health expenditures for Medicaid beneficiaries from July 1991 to June 1992.
Psychiatric ServicesCapitation Payment and Mental Health Care: A Review of the Opportunities and Risks
72 Citations1987Anthony F. Lehman
The author defines capitation within the context of various health care reimbursement approaches, presents arguments for and against capitation, reviews the record of capitation for general medical care, and discusses proposals for capitation systems for high-risk patient groups.
Health Services ResearchMental Health Costs and Access Under Alternative Capitation Systems in Colorado
57 Citations2002Joan R. Bloom, Teh‐wei Hu +5 more
Reductions in access and cost per person was reduced in the capitated areas in each of the two years following implementation of Medicaid mental health capitation in Colorado, resulting in cost reducing service changes for persons with severe mental illness.
New Directions for Mental Health ServicesCapitation in mental health: Potentials and cautions
53 Citations1989David Mechanic, Linda H. Aiken
Capitation is increasingly advocated as a budgeting strategy to consolidate resources, develop services, focus responsibility, and manage care appropriately for the long-term mentally ill.
The Journal of Behavioral Health Services & ResearchOutcomes for medicaid beneficiaries with schizophrenia under a prepaid mental health carve-out
49 Citations1999Willard G. Manning, Chuan‐Fen Liu +5 more
From 1991 to 1994, the average beneficiary's mental health status improved, but the improvement was less under the carve-out program than under traditional fee-for-service Medicaid.
American Journal of Public HealthUse of community-based mental health programs by HMOs: evidence from a Medicaid demonstration.
47 Citations1992J Christianson, Nicole Lurie +3 more
There was no strong evidence that Medicaid beneficiaries with severe mental illness who were randomly assigned to prepaid plans used community-based mental health treatment programs differently than did other Medicaid beneficiaries, however, write-offs were consistently higher for enrollees in prepaid plans.
PubMedExpenditures for mental health services in the Utah Prepaid Mental Health Plan.
45 Citations1997Tom Stoner, Warren J. Manning +3 more
The results indicate that the UPMHP reduced acute inpatient mental health expenditures and admissions for Medicaid beneficiaries during the first 2½ years of the UPGP, and had no statistically significant effect on outpatientmental health expenditures or visits.
Psychiatric ServicesA Mental Health Capitation Program: II. Cost-Benefit Analysis
43 Citations1994Sylvia K. Reed, Kevin D. Hennessy +2 more
The CPS resulted in major improvements in the community's services for persons with serious mental illness and reduced the proportion of care provided in the state hospital.
Psychiatric ServicesA Mental Health Capitation Program: I. Patient Outcomes
41 Citations1994Robert E. Cole, Sylvia K. Reed +3 more
The Monroe-Livingston demonstration project's capitation payment system (CPS) successfully maintained severely ill patients in the community but did not improve their functioning or level of symptoms.
The Journal of Behavioral Health Services & ResearchFlorida's medicaid mental health carve-out: Lessons from the first years of implementation
34 Citations1999M. Susan Ridgely, Julienne Giard +1 more
Findings suggest that the carve-out demonstration has succeeded in creating a fully integrated mental health delivery system with financial and administrative mechanisms that support a shared clinical model, but other findings raise concerns about the HMO model in terms of stability, access to care, efficiency, and more generally about the shifting of risk and public responsibility “downstream” to private organizations without sufficient governmental oversight.
Administration and Policy in Mental Health and Mental Health Services ResearchAssessment of the Massachusetts medicaid managed behavioral health program: Year three
28 Citations1997Richard H. Beinecke, Donald S. Shepard +2 more
This evaluation of the third year of the Massachusetts Medicaid managed Mental Health/Substance Abuse Program showed that overall utilization increased slightly and expenditures were nearly the same in FY1994 compared to FY1993; however, they were lower for disabled members.
JAMADoes capitation affect the health of the chronically mentally ill? Results from a randomized trial
21 Citations1992N. Lurie
Health AffairsPartial Capitation Versus Fee-For-Service in Mental Health Care
7 Citations1995David L. Shern, Sheila A. Donahue +3 more
Findings from a multiyear study involving the comparison of alternative Medicaid reimbursement systems for intensive case management services are presented: a fee-for-service arrangement developed specifically for this study, and the partial capitation system in use in New York State.
Policy Studies JournalAn Analysis of Capitation for Mental Health Services
6 Citations1994Joan R. Bloom, Garry Toerber +3 more
Several of the major issues pertaining to the utility of capitation in mental health are discussed, on-going capitation efforts are discusses, and on- going capitation programs are evaluated.