Privatized medicaid managed care in massachusetts: Disposition in child and adolescent mental health emergencies

  • Joanne Nicholson
  • Stephen Dine Young
  • Lorna J. Simon
  • William H. Fisher
  • Anne Bateman
Special Section: Public/Private Collaboration In Managing Behavioral Health Services

Abstract

Data from child and adolescent emergency mental health screening episodes prior and subsequent to privatized Medicaid managed care in Massachusetts are used to investigate the relationship between payer source and disposition and to compare the match between clinical need and disposition level of care. Having Medicaid as the payer in the post-Medicaid managed care period decreased the odds of hospitalization by nearly 60%. None of the clinical need variables that contributed to hospitalization for Medicaid episodes in the pre-Medicaid managed care period were significant in the post-Medicaid managed care period. Multiple forces shaping professional standards, decision making, and quality of care are described. Public sector agencies must lay the groundwork for comprehensive evaluation prior to the implementation of privatized Medicaid managed care initiatives.

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References

  1. 1.
    Sullivan MJ: Medicaid's quiet revolution: Merging the public and private sectors of care.Professional Psychology: Research and Practice 1995; 26:229–234.Google Scholar
  2. 2.
    Hoge MA, Davidson L, Griffith EEH, et al.: Defining managed care in public-sector psychiatry.Hospital and Community Psychiatry 1994; 45:1085–1089.Google Scholar
  3. 3.
    Geller JL: When less is more; when less is less.Psychiatric Services 1995; 46:1105.Google Scholar
  4. 4.
    Pires SA, Stroul BA, Roebuck L, et al.:Health Care Reform Tracking Project: Tracking State Health Care Reforms as They Affect Children and Adolescents with Emotional Disorders and Their Families. Tampa: Research and Training Center for Children's Mental Health, Florida Mental Health Institute, 1995.Google Scholar
  5. 5.
    Minkin EB, Stoline AM, Sharfstein SS: An analysis of the two-class system of care in public and private psychiatric hospitals.Hospital and Community Psychiatry 1994; 45:975–977.Google Scholar
  6. 6.
    Patricelli RE, Lee FC: Employer-based innovations in behavioral health benefits.Professional Psychology: Research and Practice 1996; 27:325–334.Google Scholar
  7. 7.
    Wells KB, Astrachan BM, Tischler GL, et al.: Issues and approaches in evaluating managed mental health care.The Milbank Quarterly 1995; 73:57–75.Google Scholar
  8. 8.
    Callahan JJ, Shepard DS, Beinecke RH, et al.: Mental health/substance abuse treatment in managed care: The Massachusetts Medicaid experience.Health Affairs 1995; 14:173–184.Google Scholar
  9. 9.
    Dickey B, Norton EC, Normand S, et al.: Massachusetts Medicaid managed health care reform: Treatment for the psychiatrically disabled.Advances in Health Economics and Health Research 1995; 15:99–116.Google Scholar
  10. 10.
    Nicholson J, Young SD, Simon L, et al.: Impact of Medicaid managed care on child and adolescent emergency mental health screening in Massachusetts.Psychiatric Services 1996; 47:1344–1350.Google Scholar
  11. 11.
    Stroul BA, Friedman RM:A System of Care for Severely Emotionally Disturbed Children and Youth. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1986.Google Scholar
  12. 12.
    Lourie IS, Howe SW, Roebuck LL: Private sector managed care and children's mental health.Focal Point: A National Bulletin on Family Support and Children's Mental Health 1996; 10:1–9.Google Scholar
  13. 13.
    Fisher WH, White CL, Geller JL, et al.: Predicting state vs. private hospital referral in psychiatric emergencies.Administration and Policy in Mental Health 1994; 21:449–461.Google Scholar
  14. 14.
    Marson DC, McGovern MP, Pomp HC: Psychiatric decision making in the emergency room: A research overview.American Journal of Psychiatry 1988; 145:918–925.Google Scholar
  15. 15.
    Rabinowitz J, Massad A, Fennig S: Factors influencing disposition decisions for patients seen in a psychiatric emergency service.Psychiatric Services 1995; 46:712–718.Google Scholar
  16. 16.
    Rabinowitz J, Slyuzberg S, Salamon I, et al.: A method for understanding admission decision making in a psychiatric emergency room.Psychiatric Services 1995; 46:1055–1060.Google Scholar
  17. 17.
    Way BB, Evans ME, Banks SM: Factors predicting referral to inpatient or outpatient treatment from psychiatric emergency services.Hospital and Community Psychiatry 1992; 43:703–708.Google Scholar
  18. 18.
    White CL, Bateman A, Fisher WH, et al.: Factors associated with admission to public and private hospitals from a psychiatric emergency screening site.Psychiatric Services 1995; 46:467–472.Google Scholar
  19. 19.
    Costello AJ, Dulcan MK, Kalas R: A checklist of hospitalization criteria for use with children.Hospital and Community Psychiatry 1991; 42:823–828.Google Scholar
  20. 20.
    Hillard JR, Slomowitz M, Deddens J: Determinants of emergency psychiatric admission for adolescents and adults.American Journal of Psychiatry 1988; 145:1416–1419.Google Scholar
  21. 21.
    Hillard JR, Slomowitz M, Levi LS: A retrospective study of adolescents' visits to a general hospital psychiatric emergency service.American Journal of Psychiatry 1987; 144:432–436.Google Scholar
  22. 22.
    Gutterman EM, Markowitz JS, LoConte JS, et al.: Determinants for hospitalization from an emergency mental health service.Journal of the American Academy of Child and Adolescent Psychiatry 1993; 32:114–122.Google Scholar
  23. 23.
    Fendell S: Managed care in the Medicaid mental health system: Verdict out, concerns abound.Massachusetts Mental Health Legal Advisor (March 1993), pp. 10–15.Google Scholar
  24. 24.
    Callahan JJ, Shepard DS:Evaluation of the Massachusetts Medicaid Mental Health/Substance Abuse Program. Waltham, MA: Brandeis University, Heller School for Advanced Studies in Social Welfare, January 1994.Google Scholar
  25. 25.
    Segal SP, Watson MA, Akutsu PD: Quality of care and use of less restrictive alternatives in the psychiatric emergency service.Psychiatric Services 1996; 47:623–627.Google Scholar
  26. 26.
    Freudenberger-Roth L, Schwartz J, Jaeger AC: Behavioral treatment outcomes and managed care.Psychotherapy Bulletin 1997; 32:39–44.Google Scholar
  27. 27.
    Segal SP, Egley Ll, Watson MA, et al.: Factors in the quality of patient evaluations in general hospital psychiatric emergency services.Psychiatric Services 1995; 46:1144–1148.Google Scholar
  28. 28.
    Fendell S: Mental health managed care: MHMA report card mixed; conflict between profits and consumers.Massachusetts Mental Health Legal Advisor (Spring 1994), pp. 4–12.Google Scholar
  29. 29.
    Dixon WJ, Brown MB, Engelman L, et al.:BMDP Statistical Software Manual. Vol. 2. Berkeley: University of California Press, 1990.Google Scholar
  30. 30.
    Rosner B:Fundamental Biostatistics. Second ed. Boston: Duxbury Press, 1982.Google Scholar
  31. 31.
    Hosmer DW Jr, Lemenshow S:Applied Logistic Regression. New York: John Wiley, 1989.Google Scholar
  32. 32.
    Rothman KJ:Modern Epidemiology. Boston: Little, Brown, 1986.Google Scholar
  33. 33.
    Dowart RA, Epstein SS:Privatization and Mental Health Care: A Fragile Balance. Westport, CT: Auburn House, 1993.Google Scholar
  34. 34.
    Mechanic KD, Schlesinger M, McAlpine DD: Management of mental health and substance abuse services: State of the art and early results.The Milbank Quarterly 1995; 73:19–55.Google Scholar

Copyright information

© Association of Behavioral Healthcare Management 1998

Authors and Affiliations

  • Joanne Nicholson
    • 1
  • Stephen Dine Young
    • 1
  • Lorna J. Simon
    • 1
  • William H. Fisher
    • 1
  • Anne Bateman
    • 2
  1. 1.Center for Psychosocial and Forensic Services Research, Department of PsychiatryUniversity of Massachusetts Medical SchoolWorcester
  2. 2.Northeastern UniversityBoston

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