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Special Report: Annotated Bibliography for
Managed Behavioral Health Care 1989-1999
Capitation
76. Babigian, H. M., & Reed, S. K. (1992). Capitation and management of
mental health in the public sector. In J. Feldman & R. J. Fitzpatrick (Eds.),
Managed mental health care: Administrative and clinical issues (1st ed.,
pp. 111-124). Washington, DC: American Psychiatric Press.
The authors of this chapter describe a 5-year demonstration project to address inadequacies
in caring for seriously and persistently mentally ill people in Monroe and Livingston Counties
in New York. As part of this demonstration project, both counties and the State delegated
many of their responsibilities for the chronically mentally ill to a corporation that assumed
both management of the publicly funded mental health system and coordination of the
involved parties. The chapter discusses the evolution of the capitation payment system (CPS),
the problems it addressed, and the main features of the system. The chapter describes an
experimental evaluation of the CPS program, with preliminary findings indicating that the
experimental group is using fewer hospitalization resources than the control group. On the
basis of this project, the authors conclude that capitation shows promise in providing cost-effective
quality care for persons who are chronically mentally ill.
Keywords: capitation, New York, public sector, serious mental illness
77. Babigian, H. M., Cole, R. E., Reed, S. K., Brown, S. W., & Lehman, A. F.
(1991). Methodology for evaluating the Monroe-Livingston capitation
system. Hospital and Community Psychiatry, 42, 913-919.
The Monroe-Livingston demonstration project was initiated in 1987 to coordinate the quality
and cost of mental health services to chronically mentally ill patients. This paper presents the
methodology for evaluating the Monroe-Livingston demonstration project’s capitation pay-ment
system. The authors note that because random assignment produced equivalent groups,
attrition was kept to a minimum and excellent interrater reliability was achieved. The evalua-tion
design appears sound. This study should increase our understanding of the impact of
capitation on families and patients.
Keywords: capitation, evaluation, New York, public sector, serious mental illness
78. Babigian, H. M., & Marshall, P. E. (1989). Rochester: A comprehensive
capitation experiment. New Directions for Mental Health Services, 43,
43-54.
This chapter describes a demonstration project that examines whether persons who are
chronically mentally ill can be served effectively in a capitated-financing model. The authors discuss the project design, which includes a central coordinating agency, prospective payment,
capitation, and management information systems. Examples are given to illustrate how clients
are deemed eligible. The article describes the issues and challenges that arose in implementa-tion,
such as determining capitation rates and ensuring that state hospital employees received
job security assurances. An evaluation has been undertaken to study the project’s effect on
mental health outcomes and costs.
Keywords: capitation, New York, public sector, serious mental illness
79. Brach, C. (1998). Designing substance abuse and mental health
capitation projects: Vol. 3. Managed care technical assistance series.
Rockville, MD: Substance Abuse and Mental Health Services
Administration.
This guide is meant as a reference tool for public officials in State and county substance abuse
and mental health agencies as they design capitation projects. With its overview of capitation
and answers to questions about capitation features, the guide also provides a useful foundation
to anyone interested in mental health or substance abuse capitation. The researchers identify
four relevant goals of substance abuse and mental health capitation and a 10-step plan to
becoming a purchaser of capitated substance abuse and mental health services. Each step repre-sents
a separate task for designers of capitation projects, who in considering each step review
the merits and drawbacks of different options. Steps include identifying goals, defining eligible
populations, determining the scope of services, assigning responsibilities, contracting, managing
risk, setting rates, enrolling clients, ensuring quality, and implementing the project. The guide
also includes a decision checklist as a separate appendix.
Keywords: capitation, contracting, public sector, substance abuse, technical assistance
80. Burns, B. J., Smith, J., Goldman, H. H., Barth, L. E., & Coulam, R. F.
(1989). The CHAMPUS Tidewater Demonstration Project. New Directions
for Mental Health Services, 43, 77-86.
Concern about high costs and overutilization of mental health benefits led the Office of
Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS) to design
and implement a demonstration project. This project places a contractor at risk for the cost
of care, while granting the contractor leeway to manage the care using less costly forms of
delivery. Under this contractor provider arrangement, CHAMPUS hired a contractor to pro-vide
all mental health benefits for its members. OCHAMPUS retains ultimate responsibility
and performs oversight to maintain quality control. The chapter describes the functions
performed by the contractor such as case management, processing claims, and establishing
a network of providers. The authors identify the problems that arose in implementing the
project and the questions to be answered in evaluating the project.
Keyword: capitation
81. Chandler, D., Meisel, J., Hu, T., McGowen, M., & Madison, K. (1998).
A capitated model for a cross-section of severely mentally ill clients:
Hospitalization. Community Mental Health Journal, 34(1), 13-26.
This 3-year study of the severely mentally ill (SMI) population examines hospitalization
outcomes for two capitated integrated service agencies (ISAs), one urban and one rural, in
California. The study focuses on the effectiveness of capitation and assertive treatment teams
to limit hospital admissions, lengths of stay, mean mental health costs, and other factors for
the SMI population. Using the flexibility of capitated funding and assertive treatment teams,
both ISAs established crisis response and continuity of care procedures. According to the
authors, at neither site were clients’ outcomes on hospitalization uniformly superior to those
of clients in the "usual system." However, the authors concluded that, in these two ISAs,
elements of the capitated model produced both some clinically appropriate and less costly
uses of inpatient services.
Keywords: California, capitation, evaluation, outcomes, public sector, serious mental
illness
82. Christianson, J. B., & Gray, D. Z. (1994). What CMHCs can learn from
two States’ efforts to capitate Medicaid benefits. Hospital and Community
Psychiatry, 45, 777-781.
The authors compare the Minnesota (Hennepin County) mental health capitation project with
the Utah Prepaid Health Plan. In this study, Medicaid beneficiaries were enrolled in HMOs
and the Utah Prepaid Health Plan which contracted with community mental health centers to
provide care for Medicaid eligible clients. The authors discuss pros and cons of contracting
with medical vs. mental health HMOs. They also present preliminary findings from these
demonstration projects.
Keywords: capitation, HMOs, Medicaid, Minnesota, public sector, Utah
83. Christianson, J. B., Lurie, N., Finch, M., & Moscovice, I. S. (1989).
Mainstreaming the mentally ill in HMOs. New Directions for Mental Health
Services, 43, 19-28.
The the Centers for Medicare and Medicaid Services (CMS) undertook a demonstration project in
Hennepin County, Minnesota, in order to study the ability of HMOs to cost-effectively serve
seriously mentally ill clients. For this project, Medicaid beneficiaries were randomly assigned
to receive 1 year of treatment in a prepaid health plan. The issues identified by the project
included disruption of treatment; the ability of health plans, in spite of their lack of experi-ence,
to use community resources effectively; and adverse patient selection. Although the
authors conclude that these concerns can be addressed, they raise questions as to how States
can address the problem of adverse selection if they cannot make retrospective payments to
compensate health plans that experience financial difficulties.
Keywords: capitation, HMOs, Minnesota, public sector, serious mental illness
84. Cole, R. E., Reed, S. K., Babigian, H. M., Brown, S. W., & Fray, J. (1994).
A mental health capitation program: I. Patient outcomes. Hospital and
Community Psychiatry, 45(11), 1090-1096.
Proponents of capitation have suggested that capitating payment for mental health services
both restrains high mental health care costs and improves the flexibility and responsiveness
of care. In this study, the authors evaluate the Monroe-Livingston demonstration project’s capi-tation
payment system (CPS). The experiment randomized patients into either the capitated-funding
program (experimental group) or the fee-for-service program (control group). The
authors conducted followup interviews with patients 1 and 2 years after enrollment to assess
changes in their symptoms and functioning. Additionally, the authors reviewed data files of
the membership corporation to measure patients’ utilization of inpatient care. The results
show that while patients in the experimental group utilized inpatient days less frequently than
the control group, the two groups did not differ significantly in respect to functioning or level
of symptoms.
Keywords: capitation, evaluation, New York, outcomes, public sector, serious mental
illness
85. Cutler, D. L., Bentson, H., & Winthrop, K. (1998). Mental health in the
Oregon health plan: Fragmentation or integration? Administration and
Policy in Mental Health, 25(4), 361-386.
Between 1994 and 1998, Oregon experienced a rapid change in its health care system. Since
the implementation of the Oregon Health Plan, Medicaid enrollment has expanded 50 per-cent
to include some of the working poor. In addition, since then over 75 percent of individu-als
receiving Medicaid have enrolled in HMOs, and demonstration projects have experiment-ed
with capitated behavioral health services. In this paper, the researchers examine the effects
of the transition to capitation as well as the integration of behavioral and physical health
care, using interviews with various stakeholders in the community. The paper discusses the
background of Medicaid expansion and capitation in Oregon, the development of mental
health payment rates and rate setting, the variations in both carved out and integrated mental
health models, and, using interviews with stakeholders, the successes and challenges of imple-menting
the new health plan. These interviews have revealed that the greatest challenge has
been the attempted integration of public sector behavioral health services with private sector
health plans, while the expansion and transition to capitation have been more successful.
Keywords: capitation, integration, Medicaid, Oregon, public sector
86. Dobmeyer, T. W., McKee, P. A., Miller, R. D., & Westcott, J. S. (1990).
The effect of enrollment in a prepaid health plan on utilization of a
community crisis intervention center by chronically mentally ill individuals.
Community Mental Health Journal, 26(2), 129-137.
The advent of a Medicaid Demonstration Project to enroll Medicaid beneficiaries in a prepaid
plan raised concerns among county mental health agencies in Hennepin County, Minnesota,
that the new system might lead to underprovision of mental health services by prepaid plans, and might therefore create an extra burden on county-funded mental health agencies. The
authors randomized a sample of eligible recipients into a prepaid or fee-for-service group
and examined how the effect of enrollment in a prepaid plan affected use of an emergency
crisis center by chronically mentally ill Medicaid recipients. This center had not contracted
with the prepaid plan as a service provider. The study found that the use of the center by
those enrolled in the prepaid group was slightly (statistically insignificant) lower than for the
fee-for-service group. The authors conclude that this finding may be an indication of success-ful
case management by prepaid health plans in serving chronically mentally ill patients.
Keywords: capitation, local governments, Medicaid, Minnesota, public sector, serious
mental illness, utilization
87. Hadley, T. R., & Glover, R. (1989). Philadelphia: Using Medicaid as a
basis for capitation. New Directions for Mental Health Services, 43, 65-76.
Philadelphia was one of nine cities selected by the Robert Wood Johnson Foundation and the
U.S. Department of Housing and Urban Development to develop innovative and improved
ways of providing mental health care to the chronically mentally ill population. As part of
this initiative, Philadelphia designed a Medicaid capitation demonstration project for financ-ing
and managing mental health services. This capitated arrangement includes all Medicaid-reimbursed
psychiatric services for Philadelphia residents. This article describes the project’s
design and early implementation, and also discusses early difficulties and future goals.
Keywords: capitation, local governments, Medicaid, Pennsylvania, public sector
88. Hargreaves, W. A. (1992). A capitation model for providing mental
health services in California. Hospital and Community Psychiatry, 43,
275-277.
In 1988, the California legislature adopted and funded an integrated services agency (ISA)
model of providing mental health services. State funds were appropriated for two sites, one in
rural Stanislaus County and the other in the city of Long Beach. Each site serves people who
are disabled because of their mental disorder, who show substantial functional impairment,
and who are considered public fiscal liabilities. This includes people who are being treated for
a first psychotic episode. The ISA model attempts to go beyond the strict capitation model by
providing incentives for providers to offer optimal services while maintaining cost-effectiveness.
A controlled, randomized comparison of ISAs and usual services is being conducted to evaluate
whether ISAs indeed control costs while enhancing outcomes for mentally disabled patients.
Keywords: California, capitation, public sector, serious mental illness
89. Lurie, N., Moscovice, I. S., Finch, M., Christianson, J. B., & Popkin,
M. K. (1992). Does capitation affect the health of the chronically mentally
ill? Results from a randomized trial. Journal of the American Medical
Association, 267, 3300-3304.
This study evaluated the effect on health outcomes of enrollment of chronically mentally ill
Medicaid recipients in prepaid plans and fee-for-service Medicaid. Seven hundred thirty-nine chronically mentally ill Medicaid clients were randomly assigned into either one of four capita-tion
plans or into a control group that continued to use fee-for-service care. Outcomes meas-ured
included general health status, physical and social functioning, and psychiatric symptoms.
Pre- and postdata were collected on both the client and control groups. The study found that
there was no consistent evidence of short-term adverse health effects in prepaid plan enrollees,
and it recommends conducting long-term outcome studies.
Keywords: capitation, Medicaid, outcomes, public sector, serious mental illness
90. Mauch, D. (1989). Rhode Island: An early effort at managed care.
New Directions for Mental Health Services, 43, 55-64.
This chapter describes the Rhode Island Division of Mental Health’s use of partial capitation
to discharge long-term psychiatric patients from the State mental hospital to the community.
The Transfer I program provided $4,500 per patient per year to community agencies to serve
clients who had been hospitalized continuously for at least 1 year. The Transfer II program was
initiated 5 years after Transfer I started, following a review of the limitations and accomplish-ments
of Transfer I. Transfer II clients must have been hospitalized continuously for 2 years or
longer. In both programs, providers were required to become their clients’ single, designated
manager of care. The capitated cost for Transfer II clients was set at $20,000 each. To guard
against inadequate service, community programs were required to provide core services over
and above those funded by capitation, to assign a care manager, and to track and evaluate
client functioning. The strategy resulted in the cost-effective transfer of a number of patients.
The author identifies a number of problems with this approach: lack of adequate community
care options; disincentives to serve clients with shorter lengths of stay; and inflexible capitation
rates, which lead to system instability. The author nonetheless argues that these programs have
been successful in helping individual clients live in the community and in bringing about sys-tem
change.
Keywords: capitation, public sector, Rhode Island, serious mental illness
91. McGovern, M. P., Lyons, J. S., & Pomp, H. C. (1990). Capitation
payment systems and public mental health care: Implications for
psychotherapy with the seriously mentally ill. American Journal of
Orthopsychiatry, 60, 298-304.
Two types of prospective payment have been used to control mental health costs: case-mix
models (such as diagnosis-related groups) and capitation. According to this article’s authors,
capitation models offer the most promise for cost-effectively serving chronically mentally ill
persons. The article discusses the advantages of the capitation strategy, such as integrating
resources and service provision and providing a spectrum of services including medical care.
This approach has important implications for treatment. It can result in better linkage among
treatment modalities, greater emphasis on psychosocial versus medical care, the use of rehabili-tation
and social skills training, and an emphasis on involving the patient’s family and support
network. The authors also identify potential disadvantages to using capitation, such as inade-Special quate care, reliance on unskilled paraprofessionals, and an emphasis on maintenance rather
than rehabilitation.
Keywords: capitation, serious mental illness
92. Mechanic, D., & Aiken, L. H. (Eds.). (1989). New Directions for Mental
Health Services, 43.
This volume of New Directions for Mental Health Services presents a case study approach
to capitation programs of mental health services. This work represents the perspectives of
both theoreticians and implementors. The editors specifically include both capitation "success"
as well as "failure" stories because each offer the reader unique learning opportunities.
Keywords: capitation
93. Mechanic, D., & Aiken, L. H. (1989). Capitation in mental health:
Potentials and cautions. New Directions for Mental Health Services, 43,
5-18.
Capitation is increasingly advocated as a means of solving cost and quality problems in mental
health care for chronically mentally ill persons. The authors provide examples and the history
of this strategy and discuss its limitations. Among the risks to a capitation strategy are under-serving
populations, or a lack of service entirely. There are also significant problems in "main-streaming"
chronically mentally ill persons in HMOs as well as in serving them using separate
mental health HMOs. Under capitation, certain subsets of this population are neglected and
poorly treated. There are obstacles to using capitation to consolidate financing, such as deter-mining
"fair" capitation rates; there is also reluctance by funding agencies to surrender control
of their budgets. The authors conclude that capitation holds promise as a strategy for consoli-dating
major sources of funding and contributing toward a coherent system of managed care
for the most needy patients.
Keywords: capitation, serious mental illness
94. Reed, S. K., Hennessy, K. D., Brown, S. W., & Fray, J. (1992). Capitation
from a provider’s prospective. Hospital and Community Psychiatry, 43,
1173-1175.
This article explores providers’ experiences with the capitation payments system (CPS), a
component of a mental health demonstration project in Monroe and Livingston Counties,
New York. As part of the evaluation of the impact of CPS, interviews were conducted with
administrators, program managers, and direct-care staff from both CPS lead agencies and
the State hospital. Providers interviewed identified a number of ways in which CPS enhanced
care of seriously mentally ill persons. CPS, in which funding "follows" patients, facilitates
effective use of community mental health resources, and increases staff and client empower-ment
and collaboration among agencies. The authors also discuss provider recommendations
to improve CPS and providers’ efforts to advocate for this managed care strategy’s expanded
use.
Keywords: capitation, New York, public sector, serious mental illness
95. Reed, S. K., Hennessy, K. D., Mitchell, O. S., & Babigian, H. M. (1994).
A mental health capitation program: II. Cost-benefit analysis. Hospital and
Community Psychiatry, 45, 1097-1193.
In this study, the authors examined the costs and benefits associated with a capitation demon-stration
program. The authors analyzed total costs and benefits of care for individuals in the
Monroe-Livingston demonstration project’s capitated funding program, and compared them to
the costs and benefits in a traditional fee-for-service system of care. The study distinguished
between those patients enrolled in the comprehensive plan (continuous care) and those enrolled
in the partial plan. From the results, all groups showed improvements over the previous 2
years, but continuous patients in the capitated plan were hospitalized less frequently and expe-rienced
more case management and transportation services than continuous patients in the fee-for-
service plans. The patients continuously in the capitated plan were also more likely to live
in unsupervised settings and experienced higher levels of victimization. Subjects in the partial
plan for both the capitation and fee-for-service plans differed from each other on fewer meas-ures,
and both groups reported high levels of case management and social support services and
lower levels of supervised housing. The authors conclude that the capitation payments system
resulted in major improvements in the communities’ mental health services and in decreased
utilization in inpatient services.
Keywords: capitation, costs, evaluation, New York, outcomes, serious mental illness
96. Reidy, W. J. (1993). Staff model HMOs and managed mental health
care: One plan’s experience. Psychiatric Quarterly, 64(1), 33-43.
The Community Health Plan (CHP) is a not-for-profit staff model HMO that has provided
inpatient and outpatient mental health benefits for its beneficiaries for the past 15 years. The
mental health program is organized into interdisciplinary teams of mental health professionals.
Wherever possible, the program provides outpatient over inpatient care, goal-limited rather
than long-term psychotherapy, group therapy, and psycho-educational programs. For members
with major psychiatric disorders, CHP staff provide ongoing maintenance care and case man-agement.
This article describes the structure and function of the CHP and the lessons learned
through the provision of this model of managed care.
Keywords: capitation, HMOs
97. Roth, D., Snapp, M. B., Lauber, B. G. & Clark, J. A. (1998). Consumer
turnover in service utilization patterns: Implications for capitated payment.
Administration and Policy in Mental Health, 25(3), 241-255.
The authors report the findings from a multiyear, National Institute for Mental Health
(NIMH)-funded study in Ohio, "Services in Systems: Impact on Client Outcomes," that
explored the effect of the changing mental health system on services for the severely mentally
ill (SMI) population. The study uses past service utilization to classify people by level of risk,
and then uses these findings to hypothesize on the development of risk-adjusted capitation
rates for SMI individuals. This article describes the cluster statistical analysis technique which was used on a random sample of 4,346 consumers of mental health services over a 5-year
period. The findings of this study, according to the authors, suggest caution in the implemen-tation
of risk-adjusted capitated reimbursement plans for people with SMI, because retrospec-tive
assessment of service utilization is of limited value.
Keywords: capitation, evaluation, Ohio, outcomes, public sector, serious mental illness
98. Rothbard, A. B., Hadley, T. R., Schinnar, A. P., Morgan, D., & Whitehill,
B. (1989). Philadelphia’s capitation plan for mental health services. Hospital
and Community Psychiatry, 40, 356-358.
This article describes a capitation demonstration project to deliver services cost-effectively
to Philadelphia’s chronically mentally ill Medicaid recipients. The project is overseen by a
central authority, a nonprofit corporation created by the city’s Office of Mental Health/
Mental Retardation. The authority uses strategies such as case management to control
costs. Capitation will be implemented in order to lower costs associated with high-user
clients. The authority will also use performance contracts for moderate user services.
Keywords: capitation, local governments, Medicaid, Pennsylvania, public sector,
serious mental illness
99. Santiago, J. M., & Berren, M. R. (1989). Arizona: Struggles and
resistance in implementing capitation. New Directions for Mental Health
Services, 43, 87-96.
In this chapter, the authors describe capitation pilot projects to reform Arizona’s public
mental health system. The Arizona experiment implemented four projects in Tucson and
Phoenix and one in rural Yuma. Each site received a fixed amount of money to provide
mental health services to randomly selected, indigent, mentally ill patients. The project
clinical team performed case management and delivered other services and was financially
at risk for the costs of inpatient and outpatient care. The authors discuss a number of
barriers to implementation, including insufficient capitation rates, provider resistance,
lack of market competition, and absence of safeguards against underserving populations.
Keyword: Arizona, capitation, public sector
100. Schinnar, A. P., & Rothbard, A. B. (1989). Evaluation questions for
Philadelphia’s capitation plan for mental health services. Hospital and
Community Psychiatry, 40, 681-683.
This report of the Philadelphia experiment to capitate psychiatric services for Medicaid
clients focuses on the anticipated impact of capitation on the cost, quality, and accessibility
of care to chronically mentally ill patients. The authors argue that the experience of this
large-scale demonstration in capitation financing should be watched closely by policymakers
across the country for the project’s potential impact on the substitution of outpatient for
inpatient services, on continuity of care, and on cost-shifting. Other project aspects to be observed closely include its spillover effects as well as its impact on providers and client care.
The authors argue for timely evaluation of the impact of the experiment.
Keywords: capitation, local governments, Medicaid, Pennsylvania, serious mental
illness
101. Schinnar, A. P., Rothbard, A. B., & Hadley, T. R. (1989). Opportunities
and risks in Philadelphia’s capitation financing of public psychiatric
services. Community Mental Health Journal, 25, 255-266.
This article examines the risks and benefits inherent in the reorganization of Philadelphia’s
mental health service system under a capitation financing model. The authors focus on cost
and utilization patterns, providers and their staffing patterns, treatment outcomes, and the
impact of capitation on clients. Philadelphia plans to restructure its delivery and reimburse-ment
system, creating a not-for-profit central authority to finance and manage service delivery.
Keywords: capitation, local governments, Medicaid, Pennsylvania, public sector, seri-ous
mental illness
102. Schlesinger, M. (1989). Striking a balance: Capitation, the mentally ill,
and public policy. New Directions for Mental Health Services, 43, 97-116.
The author argues that in order to meet the needs of both publicly and privately insured
chronically mentally ill persons, capitation must balance several incentives and interests.
He describes two types of incentives to limit resource use: provider capitation related to
providers’ income and nonfinancial limits on treatment. These incentives to restrict use are
counterbalanced by pressures to intervene early through practice norms favoring excessive
utilization and consumer actions. Although these are each limited, together they may counter-balance
incentives to cut costs. However, these countervailing pressures are less likely to pro-tect
chronic mentally ill persons, and this population may be subject to arbitrary denials of
care, lack of access, nonrandom distribution of risk, and inadequate monitoring. The author
suggests several remedies, including state-administered ombudsman programs and greater
risk-sharing by HMOs.
Keywords: capitation, serious mental illness
103. Substance Abuse and Mental Health Services Administration (1998).
Estimating and managing risks for the utilization and cost of mental health
and substance abuse services in a managed care environment: Vol. 4.
Managed care technical assistance series. Rockville, MD: Substance Abuse
and Mental Health Services Administration.
This manual is meant for mental health and substance abuse provider organizations to gain a
better understanding of the principles and development of risk-sharing provider payment sys-tems
used in a managed care system. SAMHSA means for this manual to be used as a training
tool, and thus, it emphasizes examples and exercises allowing the reader to understand the ter-minology
of risk management. This manual is based on the premise that as the trend toward
capitation for mental health and substance abuse services continues, risk-sharing arrangements will become an increasingly prevalent form of provider reimbursement. The appendix includes
blank worksheets, contact information, bibliography, and examples of risk-sharing calculations
to guide the reader toward a clearer understanding of the issues.
Keywords: capitation, substance abuse, technical assistance
104. Warner, R., & Huxley, P. (1998). Outcomes for people with
schizophrenia before and after Medicaid capitation at a community
agency in Colorado. Psychiatric Services, 49(6), 802-807.
This article examines the psychiatric care of Medicaid recipients under a capitated funding
mechanism. Outcomes, satisfaction, and service utilization are compared between two random
samples of 100 clients, one a year before capitation was introduced and one a year after. The
authors’ results show that hospitalization rates were generally lower after capitation and that
clients reported improved quality of life. In this study, the findings suggest that Medicaid capi-tation
led to an efficient use of treatment resources.
Keywords: capitation, Colorado, community providers, Medicaid, outcomes, public
sector, schizophrenia, serious mental illness, utilization
105. Wyant, D., Christianson, J., & Coleman, B. (1999). The financial impact
on community mental health centers of capitated contracts with Medicaid:
The Utah Prepaid Mental Health Plan. Community Mental Health Journal,
35(2), 135-152.
Sparked by Medicaid’s movement toward managed care in many States, this study examines
the financial impact of contracting with a State Medicaid program on a community mental
health center (CMHC). In particular, the researchers compared the financial experience of
three CMHCs that entered into capitated contracts with the Utah Medicaid plan with a subset
of CMHCs in Utah that maintained the traditional method of reimbursement over a 6-year
period. The analysis compared the two types of CMHCs on profitability, liquidity, and pat-terns
of investment and financing. From the results, there were relatively few differences
between the contracting and noncontracting CMHCs that did not exist prior to the change in
reimbursement options. At worst, the decision to contract had a neutral impact on financial
performance.
Keywords: capitation, community providers, Medicaid, public sector, Utah
106. Zieman, G. L. (Ed.). (1995). The complete capitation handbook: How to
design and implement at-risk contracts for behavioral healthcare. Tiburon,
CA: Centralink Publications.
This book is an installment of the National Behavioral Healthcare Library series and
describes behavioral health care financing and delivery systems of the short and intermediate
future. The first part of this book gives the history of capitation and risk, and the next part
describes business organization and management solutions that arose to deal with risk in the
managed behavioral health care delivery system. The third section includes specific instruc-tions
on how to provide health care under capitation and the fourth and fifth sections cover Special Report 40
special topics and present case studies where capitation has been used for mental health serv-ice
delivery. This book is intended to aid mental health professionals in the development,
negotiation, and management of at-risk contracts in managed behavioral health care delivery.
Keywords: capitation, contracting, providers, technical assistance
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