Two-year outcomes of fee-for-service and capitated medicaid programs for people with severe mental illness.
OBJECTIVE
To examine the effects of two models of capitation on the clinical outcomes of Medicaid beneficiaries in the state of Colorado.


METHODS
A large sample of adult, Medicaid beneficiaries with severe mental illness drawn from regions where capitation contracts were (1) awarded to local community mental health agencies (direct capitation), (2) awarded to a joint venture between local community mental health agencies and a large, private managed behavioral health organization, and (3) not awarded and care continued to be reimbursed on a fee-for-service basis.


METHODS
The three samples were compared on treatment outcomes assessed over 2 years (total n = 591).


METHODS
Study participants were interviewed by trained, clinical interviewers using a standardized protocol consisting of the GAF, BPRS, QOLI, and CAGE.


RESULTS
Outcomes were comparable across most outcome measures. When outcome diffrences were evident, they tended to favor the capitation samples.


CONCLUSIONS
Medicaid capitation in Colorado does not appear to have negatively affected the outcomes of people with severe mental illness during the first 2 years of the program. Furthermore, the type of capitation model was unrelated to outcomes in this study.
Cuffel
Brian J
BJ
United Behavioral Health, San Francisco, CA 94105, USA.
Bloom
Joan R
JR
Wallace
Neal
N
Hausman
Jaclyn W
JW
Hu
Teh-wei
TW
D000293:Adolescent; D000328:Adult; D002204:Capitation Fee; D016009:Chi-Square Distribution; D003120:Colorado; D003155:Community Mental Health Centers / Q000191:economics / Q000592:standards*; D018588:Fee-for-Service Plans / Q000191:economics / Q000592:standards*; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007358:Insurance, Psychiatric / Q000592:standards; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D008484:Medicaid / Q000458:organization & administration*; D001523:Mental Disorders / Q000191:economics; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome