Mental health costs and access under alternative capitation systems in Colorado.
OBJECTIVE
To examine service cost and access for persons with severe mental illness under Medicaid mental health capitation payment in Colorado. Capitation contracts were made with two organizational models: community mental health centers (CMHCs) that manage and deliver services (direct capitation [DC]) and joint ventures between CMHCs and a for-profit managed care firm (managed behavioral health organization, [MBHO]) and compared to fee for service (F.F.S.).


METHODS
Both primary and secondary data were collected for the year prior to the new financing policy and the following two years (1995-1998).


METHODS
A stratified random sample of 522 severely mentally ill subjects was selected from comparable geographic areas within the capitated and FFS regions of Colorado. Major variables include service cost, utilization, and access (probability of service use) derived from secondary claims data, subject reported access collected at six-month intervals, and baseline outcomes (symptoms, functioning, and quality of life).


RESULTS
In comparison to the FFS area, cost per person was reduced in the capitated areas in each of the two years following implementation. By the end of year two, cost per person was reduced by two-thirds in the MBHO areas and by one-fifth in the DC areas. Reductions in access were found for both capitated areas, although reductions in utilization for those receiving service were found only in the MBHO model.


CONCLUSIONS
Medicaid mental health capitation in Colorado resulted in cost reducing service changes for persons with severe mental illness. Assessment of outcome change is necessary to identify cost effectiveness.
Bloom
Joan R
JR
School of Public Health, University of California at Berkeley, 94720-7360, USA.
Hu
Teh-Wei
TW
Wallace
Neal
N
Cuffel
Brian
B
Hausman
Jaclyn W
JW
Sheu
Mei-Ling
ML
Scheffler
Richard
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002204:Capitation Fee; D003120:Colorado; D003155:Community Mental Health Centers / Q000191:economics* / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006297:Health Services Accessibility / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D007358:Insurance, Psychiatric / Q000191:economics*; D016018:Least-Squares Analysis; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008484:Medicaid / Q000458:organization & administration*; D001523:Mental Disorders / Q000191:economics; D017146:Models, Organizational