The 130th Annual Meeting of APHA

Abstract #43780

Aileen B. Rothbard, ScD and Eri Kuno, Phd. Psychiatry, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market Street, Rm #3132, Philadelphia, PA 19104

This study examined the effect of a quasi-public, not-for-profit managed care (MC) implementation in service use and cost for Medicaid recipients with schizophrenia. Method: A pre-post study design was used to look at changes in service patterns and costs between 1995 and 1998 in a MC site. A comparison site with similar subjects in a traditional FFS program was employed to control for external changes. Adults with a diagnosis of schizophrenia who were continuously enrolled in Medicaid and receiving Supplementary Security Income (SSI) were chosen as study subjects. Data Sources: Medicaid Eligibility and Claims data files, as well as the MC shadow claims data were obtained for the analysis. Findings: The rates of service users among SSI recipients were similar in the pre and post MC periods in both sites. Psychiatric hospitalization rates and days declined and outpatient service mix changed as well in both programs although overall outpatient use rates remained constant. Average cost per person was reduced by 7.8% in the MC site compared to 16.8% in the FFS site. Conclusions: The most impressive change resulting from the MC implementation was a shift in the share of dollars targeted to outpatient versus inpatient care. The cost reductions in MC were due to the use of financial leverage to negotiate lower per diem hospital rates. No dramatic changes in access and service mix occurred following the implementation of this unique, quasi-public model of MCO. More follow-up is required to determine the long term impact of increasing outpatient reimbursement.

Learning Objectives:

• Identify and compare variations in psychiatric service patterns and costs associated with implementation of managed care vs Fee for Service programs for patients with schizophrenia

Keywords: Public Mental Health, Sever Mental Illness

Presenting author's disclosure statement:
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.