Treatment of long-term psychiatric disorders in the managed care environment: an observational longitudinal study

In the USA, mental health expenditures have been rising at a rate that exceeds other medical expenditures. To control these costs, insurance companies and governmental agencies responsible for health benefit plans have turned to managed care companies who review utilisation of services and who negotiate fee reductions with providers. In this study, we examined changes in patterns of care and per person expenditures among Medicaid enrollees with major mental illness. We found that after the introduction of managed care, per person expenditures were reduced by about 25%, accomplished primarily by limiting hospital admissions. We also found that admissions (and the associated costs) were not shifted to the Department of Mental Health, which funds state hospital long-term care for the indigent. Measures of continuity of care were unchanged during the study period. We conclude that managed care met its cost-containment goals without shifting costs to another state agency

Managed mental health experience in Massachusetts

Medicaid managed care experience in Massachusetts indicates that costs can be contained without harmful effects, but future developments will still need careful monitoring

Managing the care of schizophrenia. Lessons from a 4-year Massachusetts Medicaid study

BACKGROUND: In 1992, Massachusetts launched a state-wide managed care plan for all Medicaid beneficiaries. METHODS: This retrospective, multi-year, cross-sectional study used administrative data from the Massachusetts Division of Medical Assistance and Department of Mental Health, consisting of claims for 16,400 disabled adult patients insured by Medicaid in Massachusetts between July 1, 1990, and June 30, 1994. The main outcome measures include annual rates of hospitalization, emergency department utilization, and follow-up care 30 days after discharge; length of inpatient stay; and per-person inpatient and outpatient expenditures. RESULTS: Between 1991 and 1994, the likelihood of an inpatient admission decreased from 29% to 24% and was accompanied by a slight reduction in length of stay (median number of bed-days per admission dropped by 3.3 days). There was a slight decrease in the number of patients who sought care in general hospital emergency department utilization. However, there was a small increase in the fraction of patients readmitted within 30 days of discharge. Medicaid and Department of Mental Health expenditures for mental health per treated beneficiary decreased slightly, from $11,060 to$10,640, during the 4-year study period. CONCLUSION: Although per-person expenditures dropped and most patient patterns of care remained the same, longer-term study is recommended to asses whether the trends can be maintained

Use of a state inpatient forensic system under managed mental health care

OBJECTIVES: One of the goals of managed mental health care has been to lower the use of inpatient psychiatric treatment. In the past, interventions that have limited hospitalization for persons with severe mental illness have led to greater involvement of these individuals with the criminal justice and forensic mental health systems. The authors examined associations between Medicaid managed mental health care in Massachusetts and rates of admission to the inpatient forensic mental health service maintained by the state\u27s mental health department. METHODS: A total of 7,996 persons who were receiving services from the department before and after the introduction of managed care were studied. A logistic regression model based on generalized estimating equations was used to identify associations between Medicaid beneficiary status and forensic hospitalization before and after the introduction of managed care. RESULTS: The overall rate of forensic hospitalization declined in the study cohort in both periods. However, no significant decline was observed in the risk of forensic hospitalization among Medicaid beneficiaries whose care had become managed. CONCLUSIONS: Although the results of this study warrant further exploration, the risk of forensic hospitalization among Medicaid beneficiaries should be considered by policy makers in the design of mental health system interventions