The effect of managed care on enrollees' service access and outcomes was examined. We followed 688 adult Medicaid recipients with severe mental illness who were enrolled in one of three health care financing conditions (i.e., a mental health carve-out, a carve-in model, or a fee-for-service arrangement) for 12 months. Using a highly structured interview protocol, we assessed the impact of financing arrangements on enrollee access and outcomes at three points over a 12 month interval. Case mix adjusted findings at Time 1 indicated that fee-for-services enrollees had greater access to mental health services and fewer symptoms compared to carve-in enrollees; carve-out enrollees reported intermediate levels of access and symptoms. Enrollees in the plan that was at-risk for pharmacy costs reported greater difficulty obtaining psychiatric medications and were less likely to be using atypical anti-psychotic agents compared to enrollees in the other two conditions. Fee-for-service enrollees reported higher levels of satisfaction with access to services, service quality, and treatment outcomes. Case mix adjusted Time 2 results indicate that many of the Time 1 differences disappeared, although fee-for-service enrollees continued to report higher levels of satisfaction. We interpret these differential changes as indicative of program maturation effects in the carve-in condition. In this presentation we will describe the three health care arrangements, summarize and compare enrollees' outcomes across conditions, including Time 3 observations and discuss how various features of the financing arrangements and service context impact enrollees' access and outcomes.
Learning Objectives: At the completion of the presentation, participants will be able describe how health care arrangments impact enrollees' access to services and their outcomes
Keywords: Managed Care, Outcomes Research
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.