Management of mental health and substance abuse services: state of the art and early results.

Managed care (MC) refers to capitated practice (HMOs), utilization management (UM), and programs of case management for persons with mental illness and problems of substance abuse. These approaches differ substantially, and within each type are variations. Management of mental health and substance abuse services is increasingly prevalent, often sharply reducing costs. Savings result from reducing inpatient hospitalization and, sometimes, by substituting less expensive services for more costly ones. Most studies of managed care, however, measure costs narrowly, neglecting shifts in costs to patients, professionals, families, and the larger community. Strategies typical of HMOs and UM may result in lower-quality care for persons with serious mental illness and problems of substance abuse. Studies on this topic are reviewed, an analytic frame of reference is presented, and research needs are defined.

[1]  H. Luft.  Health Maintenance Organizations: Dimensions of Performance , 1981 .

[2]  L. Stein.  On the abolishment of the case manager. , 1992, Health affairs.

[3]  M. Schlesinger.  On the limits of expanding health care reform: chronic care in prepaid settings. , 1986, The Milbank quarterly.

[4]  T. Mcmahon,et al.  Health maintenance organizations and their implications for psychiatry. , 1987, Hospital & community psychiatry.

[5]  Jones Kr,et al.  Impact of alcohol, drug abuse and mental health treatment on medical care utilization. A review of the research literature. , 1979 .

[6]  H. Goldman,et al.  Initial level of care and clinical status in a managed mental health program. , 1992, Hospital & community psychiatry.

[7]  J. McKay,et al.  An evaluation of the Cleveland criteria for inpatient treatment of substance abuse. , 1992, The American journal of psychiatry.

[8]  G. Bond,et al.  Assertive community treatment for frequent users of psychiatric hospitals in a large city: A controlled study , 1990, American journal of community psychology.

[9]  D. Shern,et al.  Case management as a strategy for systems change. , 1992, Health affairs.

[10]  K. Wells,et al.  Outcomes for adult outpatients with depression under prepaid or fee-for-service financing. , 1993, Archives of general psychiatry.

[11]  V. Bruce-Wolfe,et al.  The effect of intensive case management on hospitalization of patients with schizophrenia. , 1993, Hospital & community psychiatry.

[12]  S. Altshul,et al.  Alternatives to Mental Hospital Treatment , 1979 .

[13]  N. Lurie,et al.  Use of community-based mental health programs by HMOs: evidence from a Medicaid demonstration. , 1992, American journal of public health.

[14]  G. Bond,et al.  Assertive case management in three CMHCs: a controlled study. , 1988, Hospital & community psychiatry.

[15]  J. L. Franklin,et al.  An evaluation of case management. , 1987, American journal of public health.

[16]  C. Rapp,et al.  A decade of case management: A methodological review of outcome research , 1991, Community mental health journal.

[17]  R. Dorwart.  Managed mental health care: myths and realities in the 1990s. , 1990, Hospital & community psychiatry.

[18]  W. Manning,et al.  Preliminary Results of a Controlled Trial of the Effect of a Prepaid Group Practice on the Outpatient Use of Mental Health Services , 1986 .

[19]  D. Walsh,et al.  Treatment For Chemical Dependency And Mental Illness: Can This Utilization Be Managed? , 1985 .

[20]  E. Ginzberg,et al.  The Exotic Geometry of Contemporary Medical Care@@@Purchasing Power in Health: Business, the State, and Health Care Politics.@@@Health Services Research: Key to Health Policy.@@@The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals. , 1991 .

[21]  M. England,et al.  New systems to manage mental health care. , 1991, Health affairs.

[22]  Smith Rb,et al.  Focused psychiatric review: impacts on expense and utilization. , 1991 .

[23]  E. Struening,et al.  Effect of case management on rehospitalization and utilization of ambulatory care services. , 1992, Hospital & community psychiatry.

[24]  A. Hillman,et al.  Financial Incentives for Physicians in HMOs , 1987 .

[25]  Edward B. Perrin,et al.  The Medical Outcomes Study. An application of methods for monitoring the results of medical care , 1989 .

[26]  N. Lurie,et al.  Access and use of health services by chronically mentally ill Medicaid beneficiaries. , 1993 .

[27]  T. Fox,et al.  A framework for evaluating the economic impact of case management. , 1993, Hospital & community psychiatry.

[28]  A. Hillman,et al.  Contractual Arrangements Between HMOs and Primary Care Physicians: Three-Tiered HMOs and Risk Pools , 1992, Medical care.

[29]  D. Mechanic,et al.  Challenges for managed competition from chronic illness. , 1993, Health affairs.

[30]  M. Schlesinger.  Striking a balance: capitation, the mentally ill, and public policy. , 1989, New directions for mental health services.

[31]  J. McRae,et al.  Outcomes of five years of continuous intensive case management. , 1989, Hospital & community psychiatry.

[32]  H. Bailit,et al.  Utilization management as a cost-containment strategy. , 1992, Health care financing review. Annual supplement.

[33]  H. Babigian,et al.  Rochester: a comprehensive capitation experiment. , 1989, New directions for mental health services.

[34]  M. Olfson.  Assertive community treatment: an evaluation of the experimental evidence. , 1990, Hospital & community psychiatry.

[35]  B. Burns,et al.  The 'offset effect' of mental health treatment on ambulatory medical care utilization and charges. Month-by-month and grouped-month analyses of a five-year study. , 1985, Archives of general psychiatry.

[36]  D. Mechanic.  The transformation of health providers. , 1984, Health affairs.

[37]  N. Cummings,et al.  Psychiatric Services and Medical Utilization in a Prepaid Health Plan Setting: Part II , 1967 .

[38]  D. Gerstein,et al.  Treating drug problems. , 1990, The New England journal of medicine.

[39]  B. Weisbrod,et al.  Alternative to mental hospital treatment. II. Economic benefit-cost analysis. , 1980, Archives of general psychiatry.

[40]  W. Manning,et al.  Use of Outpatient Mental Health Care: Trial of a Prepaid Group Practice Versus Fee-for-Service , 1986 .

[41]  E. Skinner,et al.  Patterns of use and costs among severely mentally ill people. , 1992, Health affairs.

[42]  D. Borenstein.  Managed care: a means of rationing psychiatric treatment. , 1990, Hospital & community psychiatry.

[43]  N. Lurie,et al.  Mainstreaming the mentally ill in HMOs. , 1989, New directions for mental health services.

[44]  D. Netzer.  Paying for services , 1962 .

[45]  L. L. Lyter,et al.  The negative impacts of increased concurrent review of psychiatric inpatient care. , 1987, Hospital & community psychiatry.

[46]  K. Wells,et al.  Mental health and selection of preferred providers. Experience in three employee groups. , 1991, Medical care.