Assessment of Medicaid Managed Behavioral Health Care for Persons With Serious Mental Illness

Leff, H. Stephen; Wieman, Dow A.; McFarland, Bentson H.; Morrissey, J; Rothbard, Aileen B.; Shern, David L.; Wylie, Alyson; Boothroyd, Roger A.; Stroup, T. Scott; Allen, Isabel Elaine

doi:10.1176/appi.ps.56.10.1245

Cited by 64 publications

(14 citation statements)

References 41 publications

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“…These results are reassuring since there were concerns that managed care might lead providers to ''shortchange'' clients. Additionally, these results are consistent with other studies of rural and urban Medicaid clients before and after substance abuse treatment managed care implementation in Oregon (Deck et al, 2000;McFarland, Deck, McCamant, Gabriel, & Bigelow, 2005) and Iowa (Ettner et al, 2003), and in a multi-site study of fee for service versus managed care for Medicaid clients with serious mental illness (Leff et al, 2005). However, conditions unique to Oregon may limit generalization to other states.…”

Section: Discussionsupporting

confidence: 87%

“…Moreover, there is also interest in strategies undertaken by rural mental health providers to address challenges imposed by managed care. Therefore, as part of a national study (Leff et al, 2005;Ridgely, Mulkern, Giard, & Shern, 2002), this project examined services and outcomes for clients with serious mental illness living in some of the most rural areas of the United States.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes for Rural Medicaid Clients with Severe Mental Illness in Fee for Service versus Managed Care

Bianconi

Mahler

McFarland

2006

Adm Policy Ment Health

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This study compared outcomes for rural Medicaid clients with severe mental illness in fee for service versus managed care programs. Interviews were conducted with 305 Medicaid clients in rural Oregon (166 in fee for service and 139 in managed care). Logistic and multivariate regression analyses were used to examine client satisfaction, safety, symptoms, functioning, and family satisfaction in the fee for service versus managed care groups. There was no evidence that conversion of the Medicaid mental health system from fee for service to managed care led to changes in outcomes for rural clients with severe mental illness.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Outcomes for Rural Medicaid Clients with Severe Mental Illness in Fee for Service versus Managed Care

Bianconi

Mahler

McFarland

2006

Adm Policy Ment Health

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“…Perhaps the most extensive comparison of managed care and FFS plans to date was conducted by Leff et al (2005) through a 5-state survey of approximately 2,000 enrollees. The study employed multivariate adjustments for case mix differences, as well as bioequivalence and meta-analytic techniques.…”

Section: Comparisons Of Ffs and Managed Care Plansmentioning

confidence: 99%

A Comparison of Acute Psychiatric Care Under Medicaid Carve-Outs, HMOs, and Fee-for-Service

Hudson

Chafets

2010

Social Work in Public Health

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This study compares the use of acute psychiatric hospitalization; selected outcomes, including rehospitalization; as well as costs associated with the health maintenance organization (HMO), carve-out, and fee-for-service models as implemented in the Massachusetts Medicaid program between FY1994 and FY2000. This is a longitudinal analysis that primarily uses unduplicated individual data from the Massachusetts Case Mix database. Analyses focus on 56,518 individuals who were psychiatrically hospitalized on acute units within 57 hospitals. They employ Cox regression to compare rehospitalization among the three programs. The hypotheses were strongly supported: HMOs have the most substantial impacts in minimizing service provision, with the carve-out program having an impact intermediate between the HMO and fee-for-service programs. Lower utilization rates were associated with lower overall rates of hospitalization, shorter lengths of stay, fewer repeated stays, and less geographic access and greater displacement of psychiatric patients to medical units. The final model of rehospitalization has an overall predictive accuracy of 59.6%.

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“…The Tidewater Managed Care Study (TMCS) was part of a SAMHSA managed care initiative that examined various models and arrangements of managed mental health care in the public sector (Leff et al 2005). TMCS compared two different organizational and financing arrangements for services to adults with SMI who were enrolled in Medicaid in two regions of eastern Virginia (Fried et al 2000;Isett et al 2006;Morrissey et al 2002;Stroup et al 2001).…”

Section: Study Sitesmentioning

confidence: 99%

Managed Care and Provider Satisfaction in Mental Health Settings

Isett

Ellis

Topping

et al. 2008

Community Ment Health J

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We assess the satisfaction of mental health providers using four dimensions from the medical practice literature--degree of autonomy, relationship with patients, compensation, and administrative burden--and extend current work on professional satisfaction to include frontline service providers rather than only psychiatrists or other physicians. In contrast to results reported for primary care settings, we find that the impact of managed care on satisfaction is minimal for the mental health providers in our study of a Medicaid capitation demonstration in the southeastern US. Instead, variables relevant to everyday working conditions have an important effect on job satisfaction.

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Assessment of Medicaid Managed Behavioral Health Care for Persons With Serious Mental Illness

Cited by 64 publications

References 41 publications

Outcomes for Rural Medicaid Clients with Severe Mental Illness in Fee for Service versus Managed Care

Outcomes for Rural Medicaid Clients with Severe Mental Illness in Fee for Service versus Managed Care

A Comparison of Acute Psychiatric Care Under Medicaid Carve-Outs, HMOs, and Fee-for-Service

Managed Care and Provider Satisfaction in Mental Health Settings

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