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

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uninsured, but more impact on "soft services' such as counseling and marriage
counseling.
If behavioral managed care is successful, deinstitutionalization will increase
resulting in empty hospital beds and creating a funding problem for state hospitals
and community hospitals that serve as inpatient mental health units. States noted
that the speed and size of reductions in inpatient care was astonishing. Such
changes should be viewed as a result of managed care, not poor care; good managed
care will reallocate money to where it is needed most.
The choices states make to select plans and providers will affect consumer
satisfaction and the program's success. States stressed that individuals should not be
made to choose between their primary care provider or their mental health
provider; every effort should be made to coordinate the two. States encouraged
program developers to consider a team of providers as the PCP.
Lessons
* States should be specific about what they want to buy in managed care
and build strong expectations for consumer involvement and choices.
* Plans and providers need technical assistance and training. <strong>Managed</strong>
mental health care is different from fee-for-service; you cannot expect
providers or plans to immediately change their way of doing business
overnight. Be realistic with goals.
* Building the capacity of plans and providers should be a team effort on
everyone's part-state, consumers, plans, and providers.
* Defining 'success' in mental health managed care should be a public
process.
* Large-scale reduction of inpatient care will happen rapidly. Expect and
prepare for significant impact on hospitals, especially state-run facilities
and prepare for continuous access to outpatient care amidst this
downsizing.
* Expect and create constant input. If you think you have talked with
everyone, you haven't.
The National Academy for State Health Policy 0 8/97 IV-88