Medicaid Managed Care - U.S. Senate Special Committee on Aging

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Goals of <strong>Managed</strong> Mental Health <strong>Care</strong>
States asserted that the issue is not whether to carve out mental health managed
care, but how care can best be managed for persons with mental health needs. These
states believed that managed care can move the current medically-based system to a
system promoting prevention, rehabilitation, and recovery, but emphasized that the
goals in moving mental health services or populations into managed care must be
clear. They agreed that the goals of mental health managed care are to:
* integrate physical and mental health care to provide a seamless system
of care that treats the whole person;5
* help individuals with mental illness toward recovery and toward
maximizing their choices and independence;
* promote community-based, highly individualized services; and
* use dollars more efficiently.
While there has been considerable criticism about the cost-saving goals of managed
care, these states stressed that the current payment system of care for persons with
mental illness is not efficient for the consumers nor for the payers. Fee-for-service
<strong>Medicaid</strong> limits the types of services provided and has a strong institutional bias,
while managed care has the potential to provide more flexible, consumer-oriented
benefits. Most of the 35 states (plus the District of Columbia) offering mental health
services through managed care have used the savings from managed care to
broaden their service coverage for mental health.6
States cautioned that the growing popularity of disease management within
managed care is generally inconsistent with the goals of maximizing choice for
consumers and providing care that best addresses the needs of the whole person.
They cautioned that disease management can be medically-oriented and diagnosisbased
while the goals of the managed mental health care system are to further
functional capacity and recovery.
5 A study completed by Indiana's <strong>Medicaid</strong> agency of its non-institutionalized <strong>Medicaid</strong>
disabled population found that nearly 30% of the beneficiaries with a psychiatric diagnosis also had
serious physical health problems. Source: Collette Croze, <strong>Medicaid</strong> <strong>Managed</strong> Mental Healthcare.
(Portland, ME: National Academy for State Health Policy, 1995).
6 From the forthcoming publication by The Lewin Group: SAMHSA <strong>Managed</strong> <strong>Care</strong> Tracking
System: Phase 1, Executive Summaty to Final Report.
The National Academy for State Health Policy 0 8/97 IV-82