Managed mental health care for seriously mentally ill populations

Current Opinion in Psychiatry

Volumn 12, Issue 2, 1999, Pages 211-216

  Rothbard, Aileen B ^a,b  

^a Medical Center   (United States)

^b Ctr Mental Hlth Plcy Serv R   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

DISEASE SEVERITY; EUROPE; HEALTH CARE COST; HEALTH CARE POLICY; MANAGED CARE; MENTAL DISEASE; MENTAL HEALTH CARE; PRIVATE HEALTH INSURANCE; PUBLIC HEALTH SERVICE; REVIEW; UNITED STATES;

EID: 0033035846     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-199903000-00013     Document Type: Review

References (51)

1. 1 Miller R, Luft H. Does managed care lead to better or worse quality of care? Health Affairs 1997; 16:7-25. In this paper, a review is presented of the literature on managed care performance for HMOs, based on data from prior to 1992 before the latest round of cost cutting occurred. Results were mixed with respect to cost savings and quality of care. Findings are more difficult to interpret as plans become more complex.
2. 2 Levit K, Lazenby H, Braden B. National health spending trends in 1996. Health Affairs 1998; 17:35-51. This paper provides an excellent background in US health care spending trends in 1996. It shows the decreased rate of growth in spending that is to a great extent the result of increases in managed care enrolment.
3. 3 Rothbard A, Kuno E. The experience of long stay psychiatric patients discharged to community based settings. Int J Law Psychiatry 1999 (in press).
4. 4 Morlock LL. Recognition and treatment of mental health problems in the general health care sector. The future of mental health services research. NIMH and the US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse and Mental Health Administrations, Division of Biometry and Applied Sciences; 1989.
5. 5 Manning WG, Wells KB, Benjamin B. Use of outpatient mental health services over time in a health maintenance organization and fee-for-service plans. Am J Psychiatry 1987; 144: 283-287.
6. 6 Goldberg ID, Regier DA, Burns BJ. Use of mental health outpatient services in four organized health care settings: mental health service system reports. Washington DC: National Institute of Mental Heatlh; 1980.
7. 7 Wells K, Keeler E, Manning W. Patterns of outpatient mental health care over time: some implications for estimates of demand and for benefit design. Health Serv Res 1990; 24:773-789.
8. 8 McFarland BH. Ending the 'HMOs and the seriously mentally ill - a view from the trenches'. Commun Ment Health J 1996; 32:219-222.
9. 9 Institute of Medicine. Outcomes. In: Managing managed care: quality improvement in behavioral health. Edmunds M, Frank R, Hogan M, McCarty D, Robinson-Beale R, Weisner C (editors). Washington, DC: National Academy Press; 1997. pp. 226-240. This book provides a framework to assist purchasers in identifying the most effective behavioral managed care at the lowest costs for both public and private consumers. The task force took an evidence-based approach, and findings are therefore rigorously grounded in the research literature. The chapters provide a comprehensive examination of the most important issues in behavioral managed care today.
10. 10 Enthoven A, Singer S. The managed care backlash and the task force in California. Health Affairs 1998; 17:95-110.
11. 11 Blendon R, Brodie M, Benson J, Altman D, Levitt L, Hoff T, Hugick L. Understanding the managed care backlash. Health Affairs 1998; 17:80-94.
12. 12 Wholey D, Christianson J, Engberg J, Bryce C. HMO market structure and performance: 1985-1995. Health Affairs 1997; 16:75-84.
13. 13 Goldman W, McCulloch J, Sturm R. Costs and Use of mental health services before and after managed care. Health Affairs 1998; 17:40-52. This study of 180 000 individuals employed in a private sector company in the Western US examined mental health utilization and cost, before and after managed behavioral health care was introduced (1995-1998).
14. 14 Jensen GA, Rost K, Burton RPD, Bulycheva M. Mental Health Insurance in the 1990s: are employers offering less to more? Health Affairs 1998; 17:201-208.
15. 15 McKusick D, Mark T, King E, Harwood R, Buck J, Dilonardo J, Genuardi J. Spending for mental health and substance abuse treatment, 1996. Health Affairs 1998; 17:147-157. This paper analyzes mental health and substance abuse spending trends in the USA and provides a comprehensive picture of important shifts over time.
16. 16 Christianson J, Manning W, Lurie N, Stoner T, Gray D, Popkin M, Marriott S. Utah's prepaid mental health plan: the first year. Health Affairs 1995; 14:160-172.
17. 17 Reiger D. Mental health parity under managed care results to data and implications. Behav Healthcare Tomorrow 1998; 7: 29-31. Actuarial estimates are used to project mental health cost increases where parity between health and mental health benefits are equivalent. These estimates do not include the more seriously ill population, which has only recently been enroled in behavioral managed care programs.
18. 18 Babigian H, Mitchell O, Marshall P, Reed SK. A mental health capitation experiment: evaluating the Monroe-Livingston experience. In: Economics and mental health. Frank R, manning W (editors). Baltimore: Johns Hopkins University Press; 1992. Pp. 307-331.
19. 19 Reed SK, Babigian HM. Postmortem of the Rochester capitation experiment. Hospital Commun Psychiatry 1994; 45: 761-764.
20. 20 Popkin MK, Lurie N, Manning W, Harman J, Callies A, Gray D, Christianson J. Changes in the process of care for Medicaid patients with schizophrenia in Utah's prepaid mental health plan. Psychiatr Serv 1998; 49:518-523.
21. 21 Stoner T, Manning W, Christianson J, Gray DZ, Marriott S. Expenditures for mental health services in the Utah Prepaid Mental Health Plan. Health Care Financ Rev 1997; 18:73-93.
22. 22 Busch S. Carving-out mental health benefits to Medicaid beneficiaries: a shift toward managed care. Admin Policy Ment Health 1997; 24:301-321. This article discusses the benefits and pitfalls of mental health carve-out arrangements. Suggestions are that, by clearly delineating general health from mental health, it is more difficult to cut mental health dollars explicitly. The pros and cons of privatization are also described.
23. 23 Cypres A, Landsberg G, Spellmann M. The impact of managed care on community mental health outpatient services in New York state. Admin Policy Ment Health 1997; 24:509-521.
24. 24 Beinecke RH, Perlman SB. The impact of the Massachusetts Managed Mental Health/Substance Abuse program on outpatient mental health clinics. Commun Ment Health J 1997; 33:377-385.
25. 25 Beinecke RH, Shepard DS, Goodman M, Rivera M. Assessment of the Massachusetts Medicaid Managed Behavioral Health Program: year three. Admin Policy Ment Health 1997; 24:205-220.
26. 26 Callahan J, Shepard D, Beinecke R, Larson M, Cavanaugh D. Mental health/ substance abuse treatment in managed care: the Massachusetts Medicaid experience. Health Affairs 1995; 14:174-184.
27. 27 Dickey B, Normand S, Norton E, Azeni H, Fisher W, Altaffer F. Managing the care of schizophrenia: lessons from a 4-year Massachusetts Medicaid study. Arch Gen Psychiatry 1996; 53:945-952.
28. 28 Frank RG, McGuire TG. Savings from a medicaid carve-out for mental health and substance abuse services in Massachusetts. Psychiatr Serv 1997; 48:1147-1152.
29. 29 Finch M, Lurie N, Christianson J, Moscovice I. The treatment of alcohol and drug abuse among mentally ill Medicaid enrollees: the utilization of services prepaid versus fee-for-service care. In: Economics and mental health. Frank R, manning W (editors). Baltimore: Johns Hopkins University Press; 1992. Pp. 296-306.
30. 30 Rogers WH, Wells KB, Meredith LS, Sturm R, Burnam A. Outcomes for adult outpatients with depression under prepaid or fee-for-service financing. Arch Gen Psychiatry 1993; 50:517-525.
31. 31 Lurie N, Moscovice IS, Finch M, Christianson JB, Popkin MK. Does capitation affect the health of the chronically mentally ill: results from a national trial. JAMA 1992; 267:3300-3304.
32. 32 Mechanic D, Schlesinger M, McAlpine DD. Management of mental health and substance abuse services: state of the art and early results. Milbank Quart 1995; 73:19-53.
33. 33 Feldman S, Baler S, Penner S. The role of private-for-profit managed behavioral health in the public sector. Admin Policy Ment Health 1997; 24:379-389. An excellent description of private, not-for-profit managed care behavioral health firms in the public sector market is provided. Concerns about the treatment of highly vulnerable subsets of the public sector population are raised, given that there has been no proposal or model that shows how the for-profit sector can provide more efficient and better quality care at a rate that is generally far below private sector clients.
34. 34 Norton EC, Lindrooth RC, Dickey B. Cost shifting in a mental health carve-out for the AFDC population. Health Care Financ Rev 1997; 18:95-108.
35. 35 Chang CF, Kiser LJ, Bailey JE, Martins M, Gibson WC, Schaberg KA, et al. Tennessee's failed managed care program for mental health and substance abuse services. JAMA 1998; 279:864-869.
36. 36 Ettner S, Frank R, McGuire T, Newhouse J, Notman E. Risk adjustment of mental health and substance abuse payments. Inquiry 1998; 35:223-239. Data from private employers is used to estimate spending on mental health and substance abuse care based on several risk adjustment models. The low performance of these models in explaining variations in mental health spending and the consequences of this are discussed.
37. 37 Frank RG, McGuire TG, Newhouse JP. Risk contracts in managed mental health care. Health Affairs 1995; 14:50-64.
38. 38 Lurie N. Studying access to care in managed care environments. Health Serv Res 1997; 32:691-701.
39. 39 Lillie-Blanton M, Lyons B. Managed care and low-income populations: recent state experiences. Health Affairs 1998; 17:238-247. This paper presents findings from a Kaiser/Commonwealth Foundation five-state telephone survey of low income adults from 1995 to 1996. Differences are highlighted between managed care and FSS enrolees with respect to their access to care, the percent having a usual source of care (i.e. clinic), regular provider (i.e. primary care physician) or emergency room (denotes no regular source or provider of care).
40. 40 Stuart ME, Weinrich M. Beyond managing Medicaid costs: restructuring care. Milbank Quart 1998; 76:251-280.
41. 41 Holahan J, Zuckerman S, Evans A, Rangarajan S. Medicaid managed care in thirteen states. Health Affairs 1998; 17:43-63. The rapid expansion of Medicaid managed care programs is discussed and questions related to quality of care and the effect on safety net providers are detailed.
42. 42 Minkotf K. Public sector managed care and community mental health ideology. In: Managed mental health care in the public sector: a survival manual. Vol. 4. Minkoff K, Pollack D (editors). Singapore: Harwood Academic Publishers; 1997. pp. 13-23.
43. 43 Carrasquillo O, Himmelstein D, Woolhandler S, Bor D. Can Medicaid managed care provide continuity of care to new Medicaid enrollees? An analysis of tenure on Medicaid. Am J Public Health 1998; 88:464-466.
44. 44 Stroup ST. Managed behavioral health care in the public sector. Harvard Rev Psychiatry 1997; 5:47-49.
45. 45 Friedman B, Devers K, Hellinger F, Fraser I. Carve outs and related models of contracting for specialty care: framework and highlights of a workshop. Am J Managed Care 1998; 4(Special Issue).SP11-SP21. This informative article describes new arrangements that are emerging to deal with special 'problems' or special 'populations'. These involve contracts for all care for specific conditions, Centers of Excellence for specific treatment, and treatment for target populations within specific populations.
46. 46 Saltman R, Figueras J. Analyzing the evidence on European health care reforms. Health Affairs 1998; 17:85-108. This article discusses the 'state' versus the 'market' as the common theme in health care delivery today, with the market being held to be the major contender. The market is a hybrid in Europe according to authors and efforts amount more to decentralization and greater privatization.
47. 47 Klein R. Why Britain is reorganizing its National Mental Health Service - yet again. Health Affairs 1998; 17:111-125.
48. 48 Pate D. Observations on Britain's National Health Service. Psychiatr Serv 1998; 49:1014-1016.
49. 49 Light DW. From managed competition to managed cooperation: theory and lessons from the British experience. Milbank Quart 1997; 75:297-341. The use of competitive contracting to manage and deliver medical and behavioral health care services is the theme of this comprehensive paper, which does not believe the UK's involvement in managed competition has the right elements required for market success.
50. 50 Sabin JE, Daniels N. Lessons for US managed care from the British National Hearth Service: II. Setting priorities. Psychiatr Serv 1997; 48:469-470.
51. 51 Manderscheid RW. From many into one: addressing the crisis of quality in managed behavioral health care at the millennium. J Behav Health Serv Res 1998; 25:233-237. This paper deals with the elements required to assess the quality of behavioral health care outcomes and the organizations currently working to create a reporting and monitoring system. It urges the establishment of a dialog, development of principles for action, and promotion of a system of outcome measures.