Assessment of Medicaid managed behavioral health care for persons with serious mental illness.
OBJECTIVE
This five-site study compared Medicaid managed behavioral health programs and fee-for-service programs on use and quality of services, satisfaction, and symptoms and functioning of adults with serious mental illness.


METHODS
Adults with serious mental illness in managed care programs (N=958) and fee-for-service programs (N=1,011) in five states were interviewed after the implementation of managed care and six months later. After a multiple regression to standardize the groups for case mix differences, a meta-analysis using a random-effects model was conducted, and bioequivalence methods were used to determine whether differences were significant for clinical or policy purposes.


RESULTS
A significantly smaller proportion of the managed care group received inpatient care (5.7 percent compared with 11.5 percent). The managed care group received significantly more hours of primary care (4.9 compared with 4.5 hours) and was significantly less healthy. However, none of these differences exceed the bioequivalence criterion of 5 percent. Managed care and fee for service were "not different but not equivalent" on 20 of 34 dependent variables. Cochrane's Q statistic, which measured intersite consistency, was significant for 20 variables.


CONCLUSIONS
Managed care and fee-for-service Medicaid programs did not differ on most measures; however, a lack of sufficient power was evident for many measures. Full endorsement of managed care for vulnerable populations will require further research that assumes low penetration rates and intersite variability.
Leff
H Stephen
HS
Human Services Research Institute, 2336 Massachusetts Avenue, Cambridge, Massachusetts 02140, USA. sleff@hsri.org
Wieman
Dow A
DA
McFarland
Bentson H
BH
Morrissey
Joseph P
JP
Rothbard
Aileen
A
Shern
David L
DL
Wylie
A Michael
AM
Boothroyd
Roger A
RA
Stroup
T Scott
TS
Allen
I Elaine
IE
D000328:Adult; D018588:Fee-for-Service Plans; D005260:Female; D005431:Florida; D006254:Hawaii; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008484:Medicaid / Q000592:standards*; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards*; D009922:Oregon; D010414:Pennsylvania; D011787:Quality of Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014768:Virginia