Outcome trends for severely mentally ill persons in capitated and case managed mental health programs

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This study compared outcomes over time of persons with severe mental illness who were randomly assigned to capitated and fee for service programs. Data were collected by independent raters and case managers. The effects of capitation on linear trends for symptoms, social conflict and functioning were examined using analysis of covariance and regression. Independent variables were capitation versus fee for service funding and baseline scores on the dependent variables. Covariates were sociodemographic and clinical variables. Persons in capitated programs had slightly better outcomes on two measures: social conflict and global functional level. Initially more disturbed persons had slightly better outcomes under capitation than under fee for service funding on symptoms and social conflict, while less disturbed persons had equal or poorer outcomes. Implications of these findings for program planning and future research are discussed.

This research was supported by the Arizona Division of Behavioral Health Services and by NIMH grant 5 R01 MH44878-02.
The authors wish to thank the members of the Outside Assessment Team for their work in collecting data used in this study; Lee Sechrest, Ph.D., for his assistance in the data collection and analytic phases of the research; Ann Hohman, Ph.D., of NIMH for her support and suggestions concerning the data analysis; and their colleagues who contributed to the data collection and analyses.