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APHA Scientific Session and Event Listing

Recorded presentation

Donald S. Shepard, PhD¹, Matthew J. Neuman, MS², Sara Hartman³, Richard H. Beinecke, DPA, ACSW⁴, and Dominic Hodgkin, PhD¹. (1) Schneider Institute for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02454-9110, (781) 736-3975, Shepard@brandeis.edu, (2) Schneider Institutes for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02454, (3) Mental Health Substance Abuse Corporations of Massachusetts, 251 West Central Street., Suite 21, Natick, MA 01760, (4) Department of Public Management, Suffolk University, 8 Ashburton Place, Boston, MA 02108

Most Massachusetts Medicaid (MassHealth) enrollees must join a managed care plan. Approved plans organize behavioral health services (BHS) in one of three structures: purchaser carve-out (the Massachusetts Behavioral Health Program, MBHP), carve-out by the health plan (Managed Care Organization, MCO), and MCO carve-in. Senior state officials considered eliminating the proven MBHP, as its unadjusted costs were highest. This study systematically compares the three structures on access to services and costs. For comparability, we focused on general members by excluding enrollees in special populations (e.g., youth under the Department of Social Services), since virtually all were in one structure (MBHP). Based on members' Medicaid eligibility, MassHealth categorizes enrollees into four rating categories (RC), which predict use of BHS. The major (and lowest) RC was Families and Children. We calculated access based on the penetration rate (unduplicated service utilizers as percent of total members). MassHealth data from state fiscal year 2005 (616,000 enrollees) demonstrated a greater share of MBHP members in higher rating categories (36%) than the members of the MCO carve-out (3%) or MCO carve-in (10%). After case-mix adjusting general membership to MBHP's mix of RC, the cost of BHS per member per month was, surprisingly, lower in MBHP ($53.95) compared to the MCOs ($54.69), with their carve-out ($48.81) below their carve-in ($57.82). Among general members in the major RC, access was best in MBHP (22%) compared to the MCO carve-out (15%) or MCO carve-in (17%). Careful analysis of costs and outcomes can aid public purchasers in comparing BHS structures appropriately.

Learning Objectives:

• Understand the three structures possible for behavioral health services and the incentives in each.
• Understand how case-mix adjustment is important in comparing managed care plans.
• Understand how the application of case mix adjustment changed the finding of which type of health plan had the lowest cost and highest quality.

Keywords: Managed Care, Economic Analysis

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation