We propose a Research Center on Managed Care for Persons with Psychiatric Disorders. To achieve cost containment and monitor quality of care, the nation is increasingly relying on managed care, including for mental health care, both within the private sector and in the public mental health sector. The proposed Center promotes studies of both private sector and public sector managed care the relationship of managed care structures and activities across sectors. In particular, the Center attempts to make more explicit the activities and processes of managed care, such as utilization management, gatekeeping, and team case management, and their impacts on costs, quality, and outcomes of care for persons with psychiatric disorders in both mental health specialty and primary care practice settings. The Center features an Administrative Core which provides infrastructure support for projects. An interdisciplinary methods laboratory supports both qualitative and quantitative research studies and provides expertise on ethnic minority issues and assessing quality and outcomes of care. The Core will sponsor seminars, scientific review of projects, and development and maintenance of Center data bases, including studies such as the Medical Outcomes Study and data bases from a consortium of insurers, employers, managed mental health care companies, and public mental health agencies. The Core also provides programming support, data base management, and project administration. The Center has three research cores. The Policy Core sponsors studies of the effects of state, local, and institutional policy on structure of managed care in the public and private sectors; and studies of consequences of plan selection choices by individuals on access to, and costs of, care under managed care. The Public Sector Core sponsors studies of variations in the implementation of managed care, focusing on an evaluation of a capitation demonstration for high-utilizers of public mental health services in Los Angeles County and team case-management structure in Ventura County. In addition, the Public Sector Core develops methods of assessing quality of psychotropic medication management in managed care community treatment settings. The Private Sector Core sponsors research on variations in quality of care across minority groups with psychiatric disorder in managed care, and studies of plan structure, ethical conflicts in managed care, and clinician practice style under managed care. Each Core will use findings from these projects to develop new proposals as the Center matures. The Center's work plan is based on a conceptual model of access to care and quality of care, adapted to managed care for psychiatric disorders. The Center investigators include psychiatrists, internists, social psychologists, epidemiologists, sociologists, anthropologists, philosophers, historians, public policy analysts, economists, and biostatisticians.
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