title: Tennessee's failed managed care program for mental health and substance abuse services.
abstract: In July 1996, Tennessee initiated a managed mental health and substance abuse program called TennCare Partners. This publicly funded "carve-out" experiment started chaotically and soon deteriorated into a crisis. Many patients did not receive care or lost continuity of care, and the traditional "safety net" mental health system nearly disintegrated. This qualitative case study sought to ascertain the impact of the TennCare Partners program. It points out that the program's difficulties stemmed directly from a flawed design that spread funds previously earmarked for severely mentally ill patients across the entire Medicaid population. States contemplating similar reforms should strive to protect vulnerable patients by risk-adjusting capitation payments and by focusing resources on care for severely mentally ill persons. States should also minimize program complexity and ensure the accountability of managed care networks for their patients' behavioral health care needs.
authors.affiliation: Fogelman College of Business and Economics, University of Memphis, TN 38152, USA. cchang@cc.memphis.edu
authors.forename: C F
authors.initials: CF
authors.lastname: Chang
authors.forename: L J
authors.initials: LJ
authors.lastname: Kiser
authors.forename: J E
authors.initials: JE
authors.lastname: Bailey
authors.forename: M
authors.initials: M
authors.lastname: Martins
authors.forename: W C
authors.initials: WC
authors.lastname: Gibson
authors.forename: K A
authors.initials: KA
authors.lastname: Schaberg
authors.forename: D M
authors.initials: DM
authors.lastname: Mirvis
authors.forename: W B
authors.initials: WB
authors.lastname: Applegate
mesh_terms: D000328:Adult; D000368:Aged; D002204:Capitation Fee; D019090:Case Management; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D008489:Medical Indigency; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration*; D008875:Middle Aged; D015397:Program Evaluation; D012308:Risk Management; D013221:State Health Plans / Q000458:organization & administration*; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000458:organization & administration; D019966:Substance-Related Disorders / Q000628:therapy; D013714:Tennessee; D014481:United States