Mental health costs, other public costs, and family burden among mental health clients in capitated integrated service agencies

Abstract

This article explores the cost implications of the capitated integrated service agency (ISA) model for persons with severe and persistent mental illness. Two demonstration sites in California were chosen for a randomized comparison between an ISA model and usual care under the existing county service system. Each ISA demonstration program assumed fiscal and service responsibility for approximately 100 clients. Cost information was collected during a 3-year study period. The capitated ISAs reduced the previously skewed distribution of resources to clients and reduced family economic burden (in one site). However, they did not reduce law enforcement, health, and other nontreatment public costs. Although capitated funding enabled programmatic effectiveness and the shifting of services toward rehabilitation, it did not itself ensure such results.

Mental health costs and outcomes under alternative capitation systems in Colorado: early results

“…[5][6][7] A pilot program in California demonstrated that capitated funding provided service flexibility and shifted services towards rehabilitation, but it did not test the potential for direct cost savings. 8 Results from a two-year study in Rochester, NY, indicate that capitation does result in reduced costs, but the savings decrease over time. Thus, they found a reduction of 14 percent at the end of the first year, but only eight percent in the second year.…”

Medicaid Managed Care and the Distribution of Societal Costs for Persons With Severe Mental Illness

“…Numerous studies (4)(5)(6)(7)(8)(9)(10)(11) of managed care plans that have carved out mental health services support this claim. Cost containment in the health sector, however, can result in substituting resources from remaining fee-for-service payers (12)(13)(14) and/or other sectors, such as the state-financed mental health service system (15), criminal justice system (16,17), other human services sectors, and/or individuals, their families, and friends (18)(19)(20)(21).…”

A Tale of Two Cities: The Exploration of the Trieste Public Psychiatry Model in San Francisco

“…Meanwhile, at the local level, experiments in the provision of services were occurring that had important effects on the ways that people with serious mental illness were being treated. Group homes (Okin 1983), Assertive Community Treatment Teams (Stein and Test 1980), Clubhouses (Sweet 1999), transitional employment services (Drake et al 1996), integrated treatment such as the Village in Long Beach (Chandler et al 1997), consumer-directed and -operated programs and other services of the consumer and survivor movements (Athena 2010;Tomes 2006), all had a major impact on the treatment landscape across America. An emphasis on person-centered care, rehabilitation and recovery, community integration, and experiments in the closure of state hospitals (Okin 1995) similar to Trieste's initiatives in many places supplanted the emphasis on mere symptom control.…”