6023.0: Thursday, November 16, 2000 - 8:30 AM

Abstract #16509

Are Managed Care and Fee For Service Mental Health Systems Different, Equivalent, Both, or Neither in Persons Served, Services Utilized, Outcomes and Satisfaction: A Cross-Site Analysis

H. Stephen Leff, PhD1, Joseph Morrissey, PhD2, Aileen Rothbard, PhD3, David Shern, PhD4, Bentsen McFarland, MD5, A. Michael Wylie, PhD6, Roger Boothroyd, PhD4, Clifton M. Chow, EdM1, Christopher Amendola1, and Laura Greene, MSW1. (1) HSRI, Human Services Research Institute/Harvard Medical School, 2336 Massachusetts Avenue, Cambridge, MA 02140, 617-876-0426, chow@hsri.org, (2) Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, University of North Carolina, Chapel Hill, 725 Airport Road, Chapel Hill, NC 27599, 919-966-5829, joe_morrissey@unc.edu, (3) Center for Mental Health Policy, #713, University of Pennsylvania, 3600 Market Street, Philadelphia, PA 19012, 215-349-8707, rothbard@cmhpsr.upenn.edu, (4) Florida Mental Health Institute, University of South Florida, University of South Florida, 13301 North Bruce B. Downs Blvd, Tampa, FL 33612, 813-974-1990, shern@hal.fmhi.usf.edu, (5) Department of Psychiatry, Oregon Health Sciences University, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, OP-02, Portland, OR 97201, 503-245-6550, mcfarlandbe@chr.mts.kpnw.org, (6) Adult Mental Health Division, Department of Health, 1250 Punchbowl St. #256, Honolulu, HI 96813, 808-957-1235, wylie@hawaii.edu

Research Objective: This paper explores how five geographically distributed sites vary with respect to person served and consumer satisfaction under "carved-out" Medicaid managed and fee for service mental health care. The major question addressed is: To what extent are there common differences between managed care and fee for service plans across sites that support the idea that there are generalizable ways in which Medicaid managed and fee for service mental health care differ? Study Design: Persons under care were randomly sampled. Across sites, 797 persons were in fee for service and 502 persons were in managed care. Each person was interviewed at two points in time, six months apart. The interview protocol in each site was the same. Test-retest reliability within sites was established for items and scales. Principal Findings: We examined within and across site differences for a number of background variables and impact variables. We employed DerSimonian and Laird Random Effects model to examine main effects for managed care versus fee for service condition and the interactions between site and condition. We also employed bio-equivalency analysis to examine equivalency between the two conditions. Conclusions: These findings suggest that differences in Medcaid managed care and fee for service mental health care with respect to both background and impact variables may not be as generalizable as some theorists and policy makers may believe. Different patterns of findings across sites were more common than similar patterns.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to : 1. understand 5 types of managed care and fee for service plans in the public sector mental health system. 2. Assess the usefulness of Bio-equivalency analysis in analyzing satisfaction and outcome domains in mental health research. 3. Evaluate the policy implications of managed care and fee for service systems in eliminating health disparities among adults with severe mental illness

Keywords: Biostatistics, Managed Care

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.

The 128th Annual Meeting of APHA