Comparing provider perceptions of access and utilization management in full-risk and no-risk medicaid programs for adults with serious mental illness

  • Bruce J. Fried
  • Sharon Topping
  • Joseph P. Morrissey
  • Alan R. Ellis
  • Scott Stroup
  • Michael Blank
Articles

Abstract

This article compares provider perceptions of access to services and utilization management (UM) procedures in two Medicaid programs in the same state: a full-risk capitated managed care (MC) program and a no-risk, fee-for-service (FFS) program. Survey data were obtained from 198 mental health clinicians and administrators. The only difference found between respondents in the FFS and MC sites was that outpatient providers in the MC site reported significantly lower levels of access to high-intensity services than did providers in the FFS site (p<.001). Respondents in the two sites reported similar attitudes toward UM procedures, including a strong preference for internal over external UM procedures. These findings support the conclusion that through diffusion of UM procedures, all care in the Medicaid program for persons with a serious mental illness is managed, regardless of risk arrangement. Implications for mental health services and further research are discussed.

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Copyright information

© Association of Behavioral Healthcare Management 2000

Authors and Affiliations

  • Bruce J. Fried
    • 1
  • Sharon Topping
    • 2
  • Joseph P. Morrissey
    • 3
  • Alan R. Ellis
    • 3
  • Scott Stroup
    • 4
  • Michael Blank
    • 5
  1. 1.Department of Health Policy & AdministrationUniversity of North Carolina at Chapel HillChapel Hill
  2. 2.the College of Business Administration at the University of Southern MississippiUSA
  3. 3.the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel HillUSA
  4. 4.the Department of Psychiatry, School of Medicineat the University of North Carolina at Chapel HillUSA
  5. 5.the Department of Psychiatry, Center for Mental Health Policy and Services Researchthe University of PennsylvaniaUSA

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