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Overview Of Publicly Funded Managed Behavioral Health Care

  • Mardi Coleman
  • William Schnapp
  • Debra Hurwitz
  • Sabine Hedberg
  • Linda Cabral
  • Aniko Laszlo
  • Jay Himmelstein
Article

Abstract

Using MEDLINE and other Internet sources, the authors perform a systematic review of published literature. A total of 109 articles and reports are identified and reviewed that address the development, implementation, outcomes, and trends related to Managed behavioral health care (MBHC). MBHC remains a work in progress. States have implemented their MBHC programs in a number of ways, making interstate comparisons challenging. While managed behavioral health care can lower costs and increase access, ongoing concerns about MBHC include potential incentives to under-treat those with more severe conditions due to the nature of risk-based contracting, the tendency to focus on acute care, difficulties assuring quality and outcomes consistently across regions, and a potential cost-shift to other public agencies or systems. Success factors for MBHC programs appear to include stakeholder involvement in program and policy development, effective contract development and management, and rate adequacy.

Key words

managed behavioral health care managed behavioral health care organizations Medicaid 

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References

  1. Appelbaum, P. 2003The ’quiet’ crisis in mental health servicesHealth Affairs (Millwood)22110116CrossRefGoogle Scholar
  2. Beinecke, R.H. 1999Oversight mechanisms in public managed care programs: From little oversight to negotiations to shared decision-makingJournal of Health and Human Services Administration22139155PubMedGoogle Scholar
  3. Bergman, G.T., Bush, S. 1999State profiles, 1999, on public sector managed behavioral health careSubstance Abuse and Mental Health Services Administration (SAMHSA)Rockville, MDGoogle Scholar
  4. Bloom, J.R., Hu, T.W., Wallace, N., Cuffel, B., Hausman, J., Scheffler, R 1998Mental health costs and outcomes under alternative capitation systems in Colorado: Early resultsJournal of Mental Health Policy & Economics1313CrossRefGoogle Scholar
  5. Blount, A. 2003Integrated primary care: Organizing the evidenceFamilies, Systems & Health21121131CrossRefGoogle Scholar
  6. Brown A.J. (2000). Online at: http://www.masspsy.com/columnists/brown.Google Scholar
  7. Buck, J.A. 2003Medicaid, health care financing trends, and the future of state-based public mental health servicesPsychiatric Services54969975PubMedCrossRefGoogle Scholar
  8. Callahan, J., Shepard, D., Hodgkin, D., Larson, M.J., Beinecke, R.H., Cavanaugh, D. 1995health/substance abuse treatment in managed care: The Massachusetts Medicaid experienceHealth Affairs14173184PubMedCrossRefGoogle Scholar
  9. Carpinello, S.E., Rosenberg, S.L. 2002Best practices: New York State’s campaign to implement evidence-based practices for people with serious mental disordersPsychiatric Services53153155CrossRefPubMedGoogle Scholar
  10. Center for Mental Health Services (CMHS). (2003). Achieving the promise: Transforming mental health care in America, final report. Rockville, MD: The President’s New Freedom Commission on Mental Health, Substance Abuse and Mental Health Services Administration (SAMHSA).Google Scholar
  11. Chang, C.F., Kiser, H.J. 1998failed managed care program for mental health and substance abuse servicesJAMA279864869PubMedCrossRefGoogle Scholar
  12. Christianson, J.B., Parente, S.T., Taylor, R. 2002Defined-contribution health insurance products: Development and prospectsHealth Affairs214964PubMedCrossRefGoogle Scholar
  13. Corrigan, P.W., Steiner, L., McCracken, S.G., Blaser, B., Barr, R. 2001Strategies for disseminating evidence-based practices to staff who treat people with serious mental illnessPychiatric Services5215981606CrossRefGoogle Scholar
  14. Counsil of State Governments. (2002). Criminal justice/mental health consensus project. Lexington, KY: Council of State Governments.Google Scholar
  15. Dougherty R. (2003). CHCS informed purchasing series resource paper—reprocurement: The role of competition in changing public managed behavioral health systems.Center for Health Care Strategies, Inc.Google Scholar
  16. Forquer S., Sabin J.E. (2002). Medicaid behavioral managed care: What lies ahead. Center for Health Care Strategies, Informed Purchasing SeriesGoogle Scholar
  17. Geller, J.L. 2000The last half-century of psychiatric services as reflected in Psychiatric ServicesPsychiatric Services514167PubMedGoogle Scholar
  18. Gold, M., Mittler, J. 2000Medicaid’s complex goals: Challenges for managed care and behavioral healthHealth Care Financing Review2285101PubMedGoogle Scholar
  19. Goldman, H.H. 2003How do you pay your rent? Social policies and the President’s Mental Health CommissionHealth Affairs (Millwood)226572CrossRefGoogle Scholar
  20. Goldman, H.H., Ganju, V., Drake, R.E., Gorman, P., Hogan, M., Hyde, P.S., Morgan, O. 2001implications for implementing evidence-based practicesPsychiatric Services5215911597PubMedCrossRefGoogle Scholar
  21. Heflinger, C.A., Northrup, D.A. 2000What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contractJournal of Behavioral Health Services Research27390405PubMedCrossRefGoogle Scholar
  22. Kotler J. (2002). Seizing the moment: Redefining state mental health agency role in time of budget uncertainty. In Networks Alexandria, V.A: National Technical Assistance Center for State Mental Health Planning.Google Scholar
  23. Lambert, D, Gale, J, Bird, D, Hartley, D 2001Medicaid managed behavioral health in rural areasRural Research Center, Edmund S. Muskie School of Public Service, University of Southern MainePortland, MaineGoogle Scholar
  24. Lambert, D., Gale, J., Bird, D., Hartley, D. 2003Medicaid managed behavioral health in rural areasJournal of Rural Health192232PubMedCrossRefGoogle Scholar
  25. Ma, C., McGuire, T. 1998Costs and incentives in a behavioral health carve-outHealth Affairs175369PubMedCrossRefGoogle Scholar
  26. Mann C. (2002). The new Medicaid and CHIP Waiver initiatives. Henry J Kaiser Family Foundation.Google Scholar
  27. Mechanic, D. 1998trends in mental health policy and practiceHealth Affairs178298PubMedCrossRefGoogle Scholar
  28. Mechanic, D., Bilder, S. 2004of people with mental illness: A decade-long perspectiveHealth Affairs238495PubMedCrossRefGoogle Scholar
  29. Millbank Memorial Fund. (2000). Effective public management of mental health care: Views from states on Medicaid reforms that enhance service integration and accountability. New York: Millbank Memorial FundGoogle Scholar
  30. Mowbray, C.T., Grazier, K.L., Holter, M. 2002Managed behavioral health care in the public sector: Will it become the third shame of the StatesPsychiatric Services53157170CrossRefPubMedGoogle Scholar
  31. National Association for Mental Illness. (2003a). Access to Medication Task Force Report and Recommendations to the NAMI Board of Directors. Online at: http://www.nami.org/Content/ContentGroups/Policy/Access to Medication Task Force Report and Recommendations to the NAMI Board of Directors.htm.Google Scholar
  32. National Association for Mental Illness.(2003b). Survey of mental health courts. Washington, DC:NAMI, Center for Jail Diversion, Criminal Justice/Mental Health Consensus ProjectGoogle Scholar
  33. National Council of State Legislatures. (1998). Managed behavioral health care carveouts. Washington, DC:National Conference of State Legislatures, Health Chairs ProjectGoogle Scholar
  34. National Mental Health Association. (2002). State action under HIFA sparks concern. Washington, DC: NMHA. Online at: http://www.nmha.org/shcr/community_based/hifastateaction.cfm.Google Scholar
  35. Randel, L., Pearson, S.D., Sabin, J.E., Hyams, T., Emanuel, E.J. 2001How managed care can be ethical managed care: Public-sector managed behavioral health care: The Iowa approach to profit and community reinvestmentHealth Affairs (Millwood)204356CrossRefGoogle Scholar
  36. Ridgely, M.S., Borum, R., Petrila, J. 2001The effectiveness of involuntary outpatient treatment: Empirical evidence and the experience of eight statesRand CorporationSanta Monica, CAGoogle Scholar
  37. Rohland, B.M. 1998of Medicaid managed mental health care in Iowa: Problems and solutionsJournal of Behavioral Health Services Research25293299PubMedCrossRefGoogle Scholar
  38. Rosenbaum, S.D., Mauery, S. 2001An overview of legal developments in managed care: Caselaw and selected case studies of legal developments in state contracting for managed behavioral health servicesAcademy for Health Services Research and Policy, Behavioral Health Issue Brief SeriesWashington, DCGoogle Scholar
  39. Savela, T., Robinson, G., Crow, S. 2000Contracting for public mental health services: Opinions of managed behavioral health care organizations. (No. DHHS Publication No. (SAMHSA) 00-3438)Center for Mental Health ServicesWashington, DCGoogle Scholar
  40. Schnapp, W.B., Bayles, S., Raffoul, P.R., Schnee, S.B. 1999Privatization and the rise and fall of the public mental health safety netAdministration & Policy in Mental Health26221225CrossRefGoogle Scholar
  41. Shepard, D.S., Daley, M., Ritter, G.A., Hodgkin, D., Beinecke, R.H. 2001Effects of a statewide carve-out on spending and access to substance abuse treatment in Massachusetts, 1992–1996Health Services Research363244PubMedGoogle Scholar
  42. Substance Abuse and Mental Health Services Administration. (2000). Community support: An overview of evaluations of the Massachusetts Medicaid managed behavioral health care program. Rockville, MD:SAMHSA, CMHS ProgramsGoogle Scholar
  43. Teitelbaum, J.S., Rosenbaum, S., Burgess, W., DeCourcy, L. 1998Selected key issues in the development and drafting of public managed behavioral health care carve-out contractsIssue Brief George Washington University Center for Health Services Research & Policy3113Google Scholar
  44. The Lewin Group (2001). SAMHSA Tracking System: 2000 State Profile on Public Sector Managed Behavioral Health Care. Falls Church, VA: Lewin Group.Google Scholar
  45. U.S. Department of Health and Human Services, Office of the Inspector General (2000). Mandatory managed care: Early lessons learned by Medicaid mental health programs. Washington, DC:OEI Document. #04-97-00340Google Scholar
  46. U.S. General Accounting Office (1999). Medicaid managed care: Four states’ experiences with mental health carve-out programs. Washington, DC:United States General Accounting OfficeGoogle Scholar
  47. U.S. Public Health Service, Office of the Surgeon General (1999). Mental health: A report of the Surgeon General. Washington, DC: U.S. Public Health ServiceGoogle Scholar
  48. U.S. Public Health Service (2000). Report of the Surgeon General’s conference on children’s mental health: A national action agenda. Washington, DC: U.S. Public Health Service.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Mardi Coleman
    • 1
  • William Schnapp
    • 2
  • Debra Hurwitz
    • 1
  • Sabine Hedberg
    • 1
  • Linda Cabral
    • 1
  • Aniko Laszlo
    • 1
  • Jay Himmelstein
    • 1
  1. 1.UMass Center for Health Policy and ResearchShrewsburyUSA
  2. 2.University of Texas Medical SchoolHoustonUSA

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