Tennessee's Failed Managed Care Program for Mental Health and Substance Abuse Services

Fogelman College of Business and Economics, University of Memphis, TN 38152, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 03/1998; 279(11):864-9. DOI: 10.1001/jama.279.11.864
Source: PubMed


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.

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    • "include a portion of the uninsured working poor and the uninsurable who are not covered by Medicaid (Chang et al., 1998). "
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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.
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    • "North Carolina has lagged behind the rest of the nation vis-à-vis the big trends that have transformed the public mental health system nationally since the 1970s—deinstitutionalization, Medicaid expansion, managed care, and the shift to local mental health authorities. As a result, we avoided some of the disasters that other states found themselves in through rushing to implement these policy changes without an adequate management or alternative services infrastructure in place (Chang et al, 1998). But a price was paid for standing on the sidelines. "

    Preview · Article · Jan 2003 · North Carolina medical journal
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    • "Despite the encouraging nature of these results, some aspects of the Colorado experience and the research prevent us from concluding that capitated payment arrangements with providers or intermediary organizations do not have negative effects on the quality of mental health service delivery. Perhaps most importantly is that the state of Colorado engaged in a sound design and implementation process that averted or minimized problems that have occurred in other states (Eberle 1998). The research team observed that state mental health and Medicaid administrators obtained broad-based input on the design of the capitation program from community mental health program administrators and treatment providers, consumers and family organizations, and academically based consultants. "
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    ABSTRACT: To examine the effects of two models of capitation on the clinical outcomes of Medicaid beneficiaries in the state of Colorado. 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. The three samples were compared on treatment outcomes assessed over 2 years (total n = 591). Study participants were interviewed by trained, clinical interviewers using a standardized protocol consisting of the GAF, BPRS, QOLI, and CAGE. Outcomes were comparable across most outcome measures. When outcome diffrences were evident, they tended to favor the capitation samples. 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.
    Full-text · Article · May 2002 · Health Services Research
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