Abstract
Advocates of managed care have promised to greatly improve delivery of services to persons with serious mental illness by focusing on effectiveness and accountability. With the exception of a few beacons of success, experience shows that managed care has not delivered on its promises. This article examines several areas of the public mental health system that still have major flaws, hindering adequate provision of services. Such flaws include the absence of integration of Medicaid and the public mental health system; general lack of publicly documented performance measurements that demonstrate accountability; absence of meaningful and authentic consumer, family, and enrollee participation in service planning, implementation, and evaluation; among others. Are we ready to replicate the lessons from the few beacons of success, or will we just continue to fail persons with the most serious mental illnesses?
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REFERENCES
American Managed Behavioral Healthcare Association. (1997). Managed behavioral healthcare: 5core approaches. Washington, DC: Author.
Beinecke, R., & Lockhart, A. (1998). Provider assessment of the Massachusetts Medicaid Managed Behavioral Health Program: Year four. Administration and Policy in Mental Health, 25,411–426.
Bureau of National Affairs. (1999, June 2). Customer service problems lead to rise in dissatisfaction with managed care plans. Managed Care Reporter, p. 528.
Dewan, N., Daniels, A.S., & Greenberg, P. (1999). Quality, outcomes, and benchmark measures for behavioral healthcare. Syllabus of the Behavioral Healthcare Tomorrow Conference (pp. 111–146). Tiburon, CA: Institute for Behavioral Healthcare.
Dixon, K., & Croze, C. (1997). Improving Public/Private Partnerships In Managed Behavioral Healthcare. Behavioral Healthcare Tomorrow, 6(1), 67–75.
Faulker and Gray. Appendix B: Capitation Rates of Selected State/County Contracts. In: Medicaid Managed Behavioral Care Sourcebook 1999. (pp. 489–493). New York, NY: Faulker & Gray, 1999.
Frank, R., & Morlock, L. (1997). Managing fragmented public mental health services. New York, NY: Milbank Memorial Fund.
General Accounting Office. (1999). Medicaid managed care: Four states' experiences with mental health carveout programs. Washington, DC: Author.
Harbin, J., Hogan, Mayberg, S., Shusterman, & Croze, C. (1995). Public mental health systems, Medicaid restructuring, and managed behavioral healthcare. Behavioral Healthcare Tomorrow, 5(5), 63–69.
Hall, L.L., Edgar, E., & Flynn, L. (1997). Stand and deliver: Action call to a failing industry—The NAMI managed care report card. Arlington, VA: National Alliance for the Mentally Ill.
Health Care Financing Administration-National Academy of State Health Policy. (1999). Report to Congress: Safeguards for individuals with special health care needs enrolled in Medicaid managed care (draft). Portland, ME: National Academy of State Health Policy.
Johnston, J., & Romzek, B. (1999). Contracting and accountability in state Medicaid reform: Rhetoric, theories, and reality. Public Administration Review, 59, 383–399.
Kanapaux, W. (1998, September). Magellan gives Montana carve-out program 30 days to improve. Mental Health Weekly.
Kanapaux, W. (1998, November 2). Montana, Magellan officials reach agreement on carve-out. Mental Health Weekly.
Kanapaux, W. (1999, February 8). Montana lawmakers consider options for ailing carve-out. Mental Health Weekly.
Kanapaux, W. (1999, February 15). Montana lawmakers move toward canceling carve-out contract. Mental Health Weekly.
Kanapaux, W. (1999, February 22). Montana lawmakers vote to end carve-out. Mental Health Weekly.
Kanapaux, W. (1999, March 1). Montana lawmakers pull reins on Magellan carve-out contract. Mental Health Weekly.
Kanapaux, W. (1999, March 8). Magellan wants out of Montana carve-out contract by April 1. Mental Health Weekly.
Kanapaux, W. (1999, March 13). Magellan, Montana agree, company will pull stakes on June 30. Mental Health Weekly.
Kanapaux, W. (1999, September 20). NYC providers say carve-out offers too much for too little. Mental Health Weekly, pp.1, 4.
Kapur, K., Young, A.S., Murata, D., Sullivan, G., & Koegel, P. (1999). The economic impact of capitated care for high utilizers of public mental health services: The Los Angeles Partners Program Experience. UCLA and RAND Research Center on Managed Care for Psychiatric Disorders, Working Paper 150.
Larson, M.J., Farrelly, M., Hodgkin, D., Miller, K., Lubalin, J.S., Witt, E., McQuay, L., Simpson, J., Pepitone, A., Keme, A., & Manderscheid, R. (1998). Payments and use of services for mental health, alcohol, and other drug abuse disorders: Estimates from Medicare, Medicaid, and private health plans. In Mental Health, United States, 1998 (pp. 124–142). Washington, DC: Department of Health and Human Services, Center for Mental Health Services.
National Association of State Mental Health Program Directors, President's Steering Committee on Health Care Reform. (1993). Medicaid data analysis (internal analysis; June 13, 1994 Memo to Clinton Administration Officials). Arlington, VA: Author.
National Association of State Mental Health Program Directors. Clients served and the use of unique client identifiers by state mental health agencies. State Profile Highlight. Alexandria, VA: NASMHPD, August 2000 draft.
National Conference of State Legislatures. (1999, July 26). New report shows states making strides to protect consumers in managed care plans (press release). Denver, CO: Author.
Office of the Inspector General, U.S. Department of Health and Human Services. Mandatory Managed Care: Changes in Medicaid Mental Health Services. Washington, DC: HHS, January 2000. OEI–04–97–00340.
Pires, S., Armstrong, M., & Stroul, B. (1999). Health care reform tracking project: Tracking state managed care reforms as they affect children and adolescents with behavioral health disorders and their families. Tampa, FL: University of South Florida (in collaboration with Human Service Collaborative and Georgetown University Child Development Center).
Robinson, G. (1999). Characteristics of public behavioral managed care. Syllabus of the Behavioral Healthcare Tomorrow Conference (pp. 63–72). Tiburon, CA: Institute for Behavioral Healthcare.
Ross, E.C. (1997). Managed Behavioral Healthcare Premises, Accountable Systems of Care, and AMBHA's PERMS. Evaluation Review, 21, 318–321.
Ross, E.C. (1998). Psychosocial rehabilitation in a managed care world. International Journal of Mental Health, 27(4), 73–87.
Roth, D., Snapp, M., Lauber, B., & Clark, J. (1998). Consumer turnover in service utilization patterns: Implications for capitated payment. Administration and Policy in Mental Health, 26, 241–255.
Rudd, Terry. (1998, September 17). Magellan threatens early exit in Montana; State prepares fee-forservice backup. Managed Behavioral Health News.
Sabin, J.E., & Daniels, N. (1999). Public-sector managed behavioral health care III: Meaningful consumer and family participation. Psychiatric Services, 50, 883–885.
Shern, D.L., & Robinson, P. (1999). Evaluation of Florida's Prepaid Mental Health Plan: Year 2 report.
Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute.
Snyder, J. (1999, August 17). Judge agrees $316 million needed to improve care. The Arizona Republic.
Sturm, R. (1999). Trackingchanges in behavioral health care: How have carve-outs changed care? RAND and UCLA Working Paper No. 162.
Substance Abuse and Mental Health Services Administration. Fiscal Year 2001: Justification of Estimates for Appropriations Committees. Rockville, MD: SAMHSA, February 2000.
Zwillich, T. (1999, September). PACTs poised to spread nationally. Clinical Psychiatry News, pp. 1, 5.
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Ross, E.C. Will Managed Care Ever Deliver on Its Promises? Managed Care, Public Policy, and Consumers of Mental Health Services. Adm Policy Ment Health 28, 7–22 (2000). https://doi.org/10.1023/A:1007816415887
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DOI: https://doi.org/10.1023/A:1007816415887