We propose a 5-year continuation of the NIMH UCLA/RAND Center for Research on Managed Care for Psychiatric Disorders. The goals are to clarify the public policy and market forces that influence growth of managed care for psychiatric disorders, describe alternative forms of financing and organization of services delivery for psychiatric disorders under managed care, and estimate the impact of alternative components of managed care, such as physician reimbursement or utilization review, on access, costs, quality, and health outcomes of care for psychiatric disorders. The Center's research plans private and publicly-funded managed care and includes research on vulnerable populations, including the severely ill and minorities. The Center promotes development of new data bases and studies, facilitates completion of proposals and research papers, and provides a strong infrastructure for interdisciplinary research. The conceptual and methodological orientation bridges public poly analysis and clinical services research. The Center is organized into an Administrative Core and three Research Core. The Administrative Core provides administrative support, research assistants, and data management to Research Cores and projects. The Administrative Core also develops and supports the Managed Care Consortium, which consists of public and private managed care organizations that provide access to their data sets and participate in Center research. The Administrative Core also disseminates Center products through a Working Paper series and Web site, and promotes across-Core collaboration through a seminar series. The Center structure includes an Executive Committee and Advisory Board, comprised of researchers, consumer representation, and managed care company representatives. The Center's research agenda is accomplished through the three Research Cores. The Policy Core examines effects of insurance legislation on access to insurance and service use patterns, and the effects of alternative benefit structures and contracts for mental health care on access and costs. The Clinical Services Core examines impact of alternative forms of managed care on quality of care and evaluates quality improvement programs for psychiatric disorders within managed care. The Vulnerable Populations Core studies policies, variations in service delivery, and clinical impact of publicly funded managed care, especially managed Medicare, for persons with severe and persistent mental illness. The Center investigators include psychiatrists, internists, psychologists, nurses, economists, sociologists, statisticians, historians, and philosophers. The renewal application features 11 new projects, which build on the Center's research infrastructure and data bases.
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