Tennessee's failed managed care program for mental health and substance abuse services
ABSTRACT In July 1996, Tennessee initiated a managed mental health and substance abuse program called TennCare Partners. This publicly funded "carve-out" experiment started chaotically and soon deteriorated into a crisis. Many patients did not receive care or lost continuity of care, and the traditional "safety net" mental health system nearly disintegrated. This qualitative case study sought to ascertain the impact of the TennCare Partners program. It points out that the program's difficulties stemmed directly from a flawed design that spread funds previously earmarked for severely mentally ill patients across the entire Medicaid population. States contemplating similar reforms should strive to protect vulnerable patients by risk-adjusting capitation payments and by focusing resources on care for severely mentally ill persons. States should also minimize program complexity and ensure the accountability of managed care networks for their patients' behavioral health care needs.
SourceAvailable from: David L Shern[Show abstract] [Hide abstract]
ABSTRACT: and Introduction Abstract The rapid enrollment of Medicaid clients in private sector managed care plans has prompted considerable debate among consumers and policymakers about the extent that private sector techniques are transferable to vulnerable populations, such as persons with serious mental illness. Concern about these issues and the lack of empiric data to inform policy choices led the Substance Abuse and Mental Health Services Administration (SAMHSA) to initiate a 3-year (1996-1999) study at 21 sites to assess the impact of managed care on several vulnerable populations, including persons with serious mental illness. This article sets the background for these SAMHSA studies by addressing the relevant research findings related to the mentally ill adult population. The major question examined is whether managed care strategies, used to effect reductions in cost of mental health care in the privately insured population, can be duplicated for low-income, seriously mentally ill adults.
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ABSTRACT: Objective: This longitudinal, prospective study examines the role of specialty mental health care as provided by community-based, usual-care practice settings in predicting out-of-home placements among children served by a child welfare and juvenile justice system. Method: The mental health needs of 1,249 children from 22 counties in Tennessee were assessed when the children were referred for child welfare and juvenile justice, in-home, case man- agement services. The outpatient specialty mental health care received by the children in the 6-month period fol- lowing the referral was recorded using the Service Assessment for Children and Adolescents and reimbursement records of TennCare. Children were then followed for 1.5 years to identify those who were subsequently placed in out-of-home care. Results: A majority of the children needed specialty mental health care, but most of these children did not receive it. This is important because their need was the best predictor of subsequent out-of-home placement. The odds of an out-of-home placement in the follow-up period were reduced by 36% to 40% for those children who received specialty mental health care. Conclusions: Improved systematic screening for mental health problems and access to specialty mental health care for children referred for in-home child welfare and juvenile justice case management services are promising strategies for reducing out-of-home placements.Research on Social Work Practice 09/2006; 16(5):480-490. DOI:10.1177/1049731506287089 · 1.53 Impact Factor
Health Affairs 09/1999; 18(5):66-70. DOI:10.1377/hlthaff.18.5.66 · 4.32 Impact Factor