Comparing provider perceptions of access and utilization management in full-risk and no-risk Medicaid programs for adults with serious mental illness.
This article compares provider perceptions of access to services and utilization management (UM) procedures in two Medicaid programs in the same state: a full-risk capitated managed care (MC) program and a no-risk, fee-for-service (FFS) program. Survey data were obtained from 198 mental health clinicians and administrators. The only difference found between respondents in the FFS and MC sites was that outpatient providers in the MC site reported significantly lower levels of access to high-intensity services than did providers in the FFS site (p < .001). Respondents in the two sites reported similar attitudes toward UM procedures, including a strong preference for internal over external UM procedures. These findings support the conclusion that through diffusion of UM procedures, all care in the Medicaid program for persons with a serious mental illness is managed, regardless of risk arrangement. Implications for mental health services and further research are discussed.
Fried
B J
BJ
Department of Health Policy & Administration, University of North Carolina at Chapel Hill 27599-7400, USA. bruce_fried@unc.edu
Topping
S
S
Morrissey
J P
JP
Ellis
A R
AR
Stroup
S
S
Blank
M
M
D000328:Adult; D000704:Analysis of Variance; D002204:Capitation Fee; D018588:Fee-for-Service Plans; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration*; D018570:Risk Assessment; D014481:United States; D014600:Utilization Review