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Special Report: Annotated Bibliography for
Managed Behavioral Health Care 1989-1999
Community Mental Health Services
107. Christianson, J. B., Lurie, N., Finch, M., Moscovice, I. S., & Hartley, D.
(1992). Use of community-based mental health programs by HMOs:
Evidence from a Medicaid demonstration. American Journal of Public
Health, 82, 790-796.
This article tests the hypothesis that Medicaid beneficiaries in HMOs reduce their use of
mental health treatment programs in their communities, thereby jeopardizing the financial
viability of these programs. A randomized trial of two groups of severely mentally ill
Medicaid beneficiaries (one with traditional Medicaid benefits and one with HMO benefits)
showed no significant short-term difference in the use of community-based programs. The
authors suggest that Medicaid program administrators can minimize the disruption of on-going
treatment for beneficiaries who join prepaid groups by offering beneficiaries a choice
among prepaid plans and encouraging community treatment programs to contract with
plans to serve beneficiaries.
Keywords:community providers, evaluation, HMOs, Medicaid, serious mental illness
108. Cypres, A., Landsberg, G., & Spellman, M. (1997). The impact of
managed care on community mental health outpatient services in New
York State. Administration and Policy in Mental Health, 24(6), 509-521.
This article explores the impact of managed care on community mental health centers. It
reports the results of a survey that was administered to the directors of all licensed outpatient
mental health facilities (clinics, day treatment, and intensive outpatient psychiatric rehabilita-tion)
in New York State. Indeed, these facilities reported extensive changes in the past as well
as predicted changes in the future as a result of the impact of managed care. These changes
occurred in a variety of areas — staffing patterns, rate at which various services are offered,
revenue sources, joining managed care panels, advertising, and training — and differed
depending upon size, region, and type of facility. The survey also inquired into respondents’
experiences with and attitudes toward managed care. The study reports that directors predict
declines in the number of staff other than psychiatrists (psychologists in particular), that they
document a shift away from open-ended treatment and toward more acute and short-term
care, and that they have a variety of concerns and frustrations arising from their experiences
with managed care.
Keywords:community providers, New York
109. Feldman, S. (1994). Managed mental health — Community mental
health revisited? Managed Care Quarterly, 2(2), 13-18.
The author argues that despite the superficial differences between the community mental
health movement of the 1960s and the current managed care movement, there may be a
greater commonality in processes, values, and objectives between them than is readily appar-ent.
Both focus on alternatives to hospitalization; both appear to have in common a belief in
the value of continuity of care, the responsibility for a defined population, and recognition of
the importance of easy access and early intervention. Because of these similarities, lessons from
community mental health may be applicable to managed care, and, in particular, the impor-tance
of an academic base for training and research and the potentially negative impact of
oversell and inflated expectations.
Keywords:community providers
110. Ray, C., & Oss, M. (1993). Community mental health and managed
care. New Directions for Mental Health Services, 59, 89-98.
Community mental health centers (CMHCs) face a number of challenges if they are to func-tion
effectively in an era of managed care. The authors argue that CMHCs must balance their
social mission to provide mental health care to high-risk populations with a new sophistication
about finance, marketing, and operating in a managed environment. Using examples from the
experiences of Massachusetts CMHCs, the authors lay out options for CMHCs in their
attempt to survive in this new environment. The article concludes with a discussion of the
opportunities for CMHCs to be major participants in the movement toward managed mental
health care.
Keywords:community providers
111. Young, A. S., Sullivan, G., Murata, D., Sturm, R., & Koegel, P. (1998).
Implementing publicly funded risk contracts with community mental health
organizations. Psychiatric Services, 49(12), 1579-1584.
This article presents a case study of the Los Angeles County Partners Program, a contractual
arrangement for services for severely mentally ill individuals between Los Angeles County
Department of Mental Health and community mental health organizations. By providing a
fixed annual rate per enrolled patient, the program shifted the financial risk for treatment to
community organizations. From both qualitative and quantitative data, the researchers found
that the new approach geared toward the most expensive patients enhanced programs’ flexibil-ity
and accountability and increased their emphasis on principles of psychosocial rehabilitation.
The article discusses challenges in implementation including disenrollment, limitations with
existing information systems, and changes necessitated by risk contracting in general. They
conclude that although mental health authorities planning to institute risk contracts need to
balance fiscal incentives with performance guarantees, risk contracting offers great opportunity
to improve service delivery.
Keywords:California, capitation, community providers, local governments, public sector,
serious mental illness
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