Portal de Periódicos da CAPES

States' Embrace of Managed Mental Health Care

1995; Project HOPE; Volume: 14; Issue: 3 Linguagem: Inglês

10.1377/hlthaff.14.3.34

2694-233X

Susan M. Essock, Howard H. Goldman,

Healthcare innovation and challenges

Prologue: Much of the mental health services provided in this country have come from the states, whose historical responsibility has been to care for the most disabled persons with the greatest need. In a sense, the state mental health authorities (SMHAs) have been an island around which swirled the turbulent waters of a managed care-driven marketplace. More states have been led by economic necessity and legislative mandate to embrace managed care to meet the needs of the vulnerable populations that depend on them. Now SMHAs find themselves needing the tools that private vendors of managed mental health services have perfected over the past decade, such as management information systems, incentive contracts, and fee negotiation. States have valuable experience working in an environment of limited resources and rigid bureaucracies, but they lack these tools of managed care. This has prevented them from moving to a higher level of cost containment and efficiency building. Because they entered the managed care market "late," they must buy the expertise they need. In this paper Susan Essock and Howard Goldman discuss the extent to which states have embraced managed mental health care and outline some of the dilemmas states face in doing so. The authors express concern that the needs of the most severely disabled do not get trampled on or overlooked, as SMHAs deal with private-sector companies that are driven by a profit motive, and as they attempt to contain their own costs. Essock is director of psychological services for the Connecticut Department of Mental Health, a position she has held since 1987. She received a doctorate in psychology from Brown University. Goldman is director of the Mental Health Policy Studies Program at the University of Maryland School of Medicine in Baltimore. He holds a joint medical degree/master of public health degree from Harvard and a doctorate in social welfare research from Brandeis University. Abstract: Historically, state mental health authorities have dominated public mental health services, operating with fixed resources and responsible for a large population. A good public mental health system has many of the attributes of a well-managed private mental health system. Unfortunately, public systems are not flexible enough to contract creatively with multiple providers; they lack many of the tools of modern managed care. As a consequence, state mental health authorities have begun to contract with private managed care firms to assist them in managing their health care reform efforts, particularly reform of Medicaid. This paper examines the forces shaping managed behavioral health care in the public sector and describes strategies for managing care, such as contracting, utilization review, and monitoring.