What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract.
Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact--at both the service system and the individual consumer level--pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector, and ratings of service system performance and coordination fell.
Heflinger
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Vanderbilt Institute of Public Policy Studies, Vanderbilt University, Nashville, TN 37203, USA. c.heflinger@vanderbilt.edu
Northrup
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D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data; D002204:Capitation Fee; D002648:Child; D003361:Cost Allocation / Q000706:statistics & numerical data; D006264:Health Benefit Plans, Employee; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D009657:North Carolina; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014600:Utilization Review / Q000592:standards / Q000706:statistics & numerical data*