Abstract
This study examines the impact of a mental health carve-out program in Utah on mental health status of Medicaid beneficiaries with schizophrenia. Three community mental health centers contracted to provide mental health care for all Medicaid beneficiaries in their service areas under managed care arrangements, while beneficiaries in the remainder of the state remained under traditional Medicaid. A pre-post evaluation was utilized, with a contemporaneous control group of Utah Medicaid beneficiaries with schizophrenia under traditional Medicaid. From 1991 to 1994, the average beneficiary's mental health status improved, but the improvement was less under the carve-out program than under traditional fee-for-service Medicaid. The difference was the greatest for beneficiaries with the worst mental health status at baseline, with effects growing over time. Medicaid beneficiaries with schizophrenia experienced less improvement in mental health status under a carve-out arrangement for mental health care compared to what would have happened under traditional Medicaid.
This is a preview of subscription content, log in via an institution to check access.
References
Mechanic D, Schlesinger A, McApline D: Management of mental health and substance abuse services: State of the art and early results.Milbank Quarterly 1995; 73:19–55.
Goldman W, McCulloch J, Sturm R: Costs and use of mental health services before and after managed care.Health Affairs 1998; 17:40–52.
Ma A, McGuire T: Costs and incentives in a behavioral health carve-out.Health Affairs 1998; 17(2):53–69.
Essock S, Goldman H: States' embrace of managed mental health care.Health Affairs 1995; 14:35–44.
Koyanagi C:Mental Health Managed Care: Survey of the States. Washington, DC: Bazelon Center for Mental Health Law, 1996.
Leadholm B, Kerznei J: Implementing a system of public managd care: The Massachusetts experience.Behavioral Health Care Tomorrow 1993; July/August:36–38.
Micali P, Naideni C: Merit Behavioral Care in Iowa: A case study.Behavioral Health Management 1996; 16:5–7.
Dickey B, Norton E, Normand S, et al.: Massachusetts Medicaid managed health care reform: Treatment of the psychiatrically disabled. In: Scheffler R, Rossiter L, Cantor J (Eds.):Advances in Health Economics and Health Services Research 1995; 15:99–116.
Callahan J, Shepard D, Beinecke R, et al.: Mental health/substance abuse treatment in managed care: The Massachusetts Medicaid experience.Health Affairs 1995; 14:173–184.
Dickey B, Normand S, Norton E, et al.: Managing the care of schizophrenia.Archives of General Psychiatry 1996; 53(10):945–952.
Babigan A, Mitchell O, Marshall P, et al.: A mental health capitation experiment: Evaluating the Monroe Livingston experience. In: Frank R, Manning W (Eds.):Economics and Mental Health. Baltimore: Johns Hopkins University Press, 1992.
Dwyer D, Mitchell O, Cole R, et al.:Evaluating Mental Health Capitation Treatment: Lessons from Panel Data. Working Paper 5297. Cambridge, MA: National Bureau of Economic Research, 1995.
Reid S, Hennessy K, Mitchell O, et al.: A mental health capitation program II: Cost benefit analysis.Hospital and Community Psychiatry 1994; 45:1097–1103.
Houseman J, Wallace N, Bloom J: Managed mental health experience in Colorado. In: Mechanic D (Ed.):Managed Behavioral Health Care: Current Realities and Future Potential. New Directions for Mental Health Services No. 78. San Francisco: Jossey-Bass, 1998.
Dangerfield D, Betet R: Managed mental health care in the public sector. In: Goldman W, Feldman S (Eds.):Managed Mental Health Care. New Directions for Mental Health Services No. 59. San Francisco: Jossey-Bass, 1993.
Christianson JB, Gray DZ, Kihlstrom LC, et al.: Development of the Utah Prepaid Mental Health Plan.Advances in Health Economics and Health Research 1995; 15:117–135.
Christianson J, Manning W, Lurie N, et al.: Utah's prepaid mental health plan: The first year.Health Affairs 1995; 14:160–172.
Stoner T, Manning W, Christianson J, et al.: Expenditures for mental health services in the Utah Prepaid Mental Health Plan.Health Care Financing Review 1997; 18:73–93.
Lurie N, Moscovice I, Popkin M, et al.: Accuracy of Medicaid claims for psychiatric diagnoses: Experience with the diagnosis of schizophrenia.Hospital and Community Psychiatry 1992; 43:69–71.
Liu C, Manning W, Christianson J, et al.: Patterns of outpatient use of mental health services for Medicaid beneficiaries under a prepaid mental health carve-out.Administration and Policy in Mental Health. In press.
Popin M, Callies A, Luri N, et al.: An instrument to evaluate the process of psychiatric care in ambulatory settings.Psychiatric Services 1997; 48:524–527.
Popkin M, Lurie L, Manning W, et al.: Changes in the process of care for Medicaid patients with schizophrenia in Utah's prepaid mental health plan.Psychiatric Services 1998; 49(4):518–523.
Endicott J, Spitzer RL, Fleiss J, et al.: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance.Archives of General Psychiatry 1976; 33:766–771.
Overall JE, Gorham DR: The Brief Psychiatric Rating Scale.Psychological Report 1962; 10:799–812.
Davies AR, Ware JE:Measuring Health Perceptions: The RAND Health Insurance Experiment. R-2711-HHS. Santa Monica, CA: RAND, 1981.
Huber PJ: The behavior of maximum likelihood estimates under non-standard conditions.Proceedings of the Fifth Berkeley Symposium in Mathematical Statistics and Probability 1965; 1:221–233.
STATA Reference Manual: Release 4. College Station, TX: Stata, 1994.
Harman JS, Manning WG, Lurie N:Interpreting Clinical and Policy Significance in Mental Health Services Research. Unpublished manuscript, 1996.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Manning, W.G., Liu, CF., Stoner, T.J. et al. Outcomes for medicaid beneficiaries with schizophrenia under a prepaid mental health carve-out. The Journal of Behavioral Health Services & Research 26, 442–450 (1999). https://doi.org/10.1007/BF02287304
Issue Date:
DOI: https://doi.org/10.1007/BF02287304