Overview Of Publicly Funded Managed Behavioral Health Care

Abstract

Using MEDLINE and other Internet sources, the authors perform a systematic review of published literature. A total of 109 articles and reports are identified and reviewed that address the development, implementation, outcomes, and trends related to Managed behavioral health care (MBHC). MBHC remains a work in progress. States have implemented their MBHC programs in a number of ways, making interstate comparisons challenging. While managed behavioral health care can lower costs and increase access, ongoing concerns about MBHC include potential incentives to under-treat those with more severe conditions due to the nature of risk-based contracting, the tendency to focus on acute care, difficulties assuring quality and outcomes consistently across regions, and a potential cost-shift to other public agencies or systems. Success factors for MBHC programs appear to include stakeholder involvement in program and policy development, effective contract development and management, and rate adequacy.

National Trends in Outpatient Psychotherapy

“…National rates and general patterns of psychotherapy use have remained remarkably consistent despite important changes in the private and public fi nancing of mental health care (15,16). Beginning on January 1, 1998, the federal Mental Health Parity Act prohibited employerbased group health plans with more than 50 workers from having different annual lifetime benefi t limits for mental health and general medical illnesses (17).…”

Managed Behavioral Health Care Carve-Outs: Past Performance and Future Prospects

“…This is especially important given that prescription drug spending has been growing during a period when inpatient and outpatient mental health care has not been growing. Last, some evidence indicates that the impact of a carve-out may change over time as it is implemented and matures (16), so results at a given point in time may not hold true over the long term.…”

“…4 Frank & Lave's 2003 review of studies (25) shows cost savings in Colorado, Massachusetts, North Carolina, and Utah ranging from 17% to 33%. Some more recent reviews note that some states with immediate cost decreases have found that the declines may have represented one-time savings because these levels were difficult to sustain over time (6,16,59 (25) note that the similarity of cost savings in studies that examine only services included in the carve-out and those that examine all behavioral health services (regardless of contractual responsibility) indicates minimal cost shifting to primary care providers. Similarly, Cuffel et al (18) explicitly compare costs for general medical care before and after a carve-out and find lower overall health care spending after the carve-out.…”

Evaluation of new flexible and integrative psychiatric treatment models in Germany- assessment and preliminary validation of specific program components

“…1). Service providers receive a total budget for all forms of inpatient and hospital-based outpatient care (capitation principle [14, 15]). This budget must cover all expenses, yet, leaving sufficient space for adapting treatments to the needs of a region or patient.

Fig.

…”