The 130th Annual Meeting of APHA

Abstract #44679

Rafael M. Semansky, MPP and Chris Koyanagi. Bazelon Center for Mental Health Law, 1101 Fifteenth Street, N.W., Suite 1212, Washington, DC 20005, (202) 467-5730 ext. 123, rafaels@bazelon.org

The Institute of Medicine (2001) identifies care coordination as one of the health care system's major organizational challenges. States have several options delivering Medicaid services to individuals with mental illness (Hanson and Huskamp, 2001). There is increasing support of integrated financing arrangements in which a single health plan is responsible for physical and behavioral health services (Zimmerman, et al. 2001; AMA, 2000). Few studies have examined whether the actual delivery of health services is coordinated at the patient level (S. Hoag, 2001; D. Shern 2001; Pires, Stroul, and Armstrong, 2000).

From April to June 2002, in-depth case studies of Medicaid managed care programs were conducted in four states. Several factors directed state selection: program maturity, state emphasis on coordinated care, and delivery system. Oklahoma and Oregon contract with health plans responsible for both physical health and mental health care. Michigan and Pennsylvania contract with specialized behavioral health organizations. The case studies involved a comprehensive review of managed care contracts, available studies and reports, on-site visits, and telephone interviews. Five general areas were examined: early identification; access to primary care and behavioral health; information sharing; provider roles and relationships; available services; and linkages with community services. During the site visits, a broad range of stakeholders were interviewed (state officials, health plans, physical and behavioral health providers, and consumers).

The presentation will examine the impact of managed care contract requirements on developing better coordinated care, discuss successful practices that innovative public purchasers and clinical programs have developed, and describe several successful efforts.

Learning Objectives: At the conclusion of the session, the participant in the session will be able to

• Identify managed care contract requirements that support better coordinated care.
• Discuss successful practices that innovative public purchasers and clinical programs have developed.
• Describe several successful efforts at improving care coordination for adults with serious mental illness and children with serious emotional disturbance.

Keywords: Managed Care, Research

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.