Most research on managed mental health care has focused on its direct clinical and fiscal impacts on mental health services. However, its impacts on other systems remain largely unknown. These potential intersystem effects are especially important as a large number of persons with mental health services needs are detained in jails, and jail detention rates continue their astronomical rise. This proposal presents a research plan for a three-year longitudinal study (2002-2005) of the impact of Medicaid capitation on the use of multiple systems of rare in King County (Seattle) Washington. This is the first comprehensive, population based effort to assess the inter-system impacts of managed behavioral health care and cost shifting from behavioral health to local jails. In a preliminary study, we obtained records on 50,000 King County residents from 1993-1998. To assess the effects of capitation, we will gather additional data on this same (prevalence) cohort, plus an additional 50,000 new subjects for the five-year time period of 1999-2003. These additional cohorts will be selected from the Medicaid enrollment records, jail detention records, and mental health utilization records, and will use our previous methodology that over-samples subjects who have records in multiple systems. As we have done before, we propose to draw electronic utilization records maintained by six different state and local agencies, that will include utilization records from mental health providers, substance abuse providers, jails and jail based clinicians, general hospitals, and general Medicaid providers. Analyses will consist of econometric modeling and hierarchical regressions and multinumeral logits to assess the impact of managed care on overall trends, intersystem service use, and cost-shifting. Findings will be targeted to a variety of local and national audiences concerned about improving care for the various population groups involved.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH063883-02
Application #
6654898
Study Section
Special Emphasis Panel (ZMH1-SRV-C (01))
Program Officer
Juliano-Bult, Denise M
Project Start
2002-09-01
Project End
2006-02-28
Budget Start
2003-09-01
Budget End
2004-08-31
Support Year
2
Fiscal Year
2003
Total Cost
$633,747
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Psychiatry
Type
Schools of Medicine
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Yoon, Jangho; Domino, Marisa E; Norton, Edward C et al. (2013) The impact of changes in psychiatric bed supply on jail use by persons with severe mental illness. J Ment Health Policy Econ 16:81-92
Cuddeback, Gary S; Morrissey, Joseph P (2011) Program planning and staff competencies for forensic assertive community treatment: ACT-eligible versus FACT-eligible consumers. J Am Psychiatr Nurses Assoc 17:90-7
Cuddeback, Gary S; Scheyett, Anna; Pettus-Davis, Carrie et al. (2010) General medical problems of incarcerated persons with severe and persistent mental illness: a population-based study. Psychiatr Serv 61:45-9
Cuddeback, Gary S; Morrissey, Joseph P; Cusack, Karen J (2008) How many forensic assertive community treatment teams do we need? Psychiatr Serv 59:205-8
Morrissey, Joseph P; Cuddeback, Gary S; Cuellar, Alison Evans et al. (2007) The role of Medicaid enrollment and outpatient service use in jail recidivism among persons with severe mental illness. Psychiatr Serv 58:794-801
Morrissey, Joseph P; Steadman, Henry J; Dalton, Kathleen M et al. (2006) Medicaid enrollment and mental health service use following release of jail detainees with severe mental illness. Psychiatr Serv 57:809-15
Norton, Edward C; Yoon, Jangho; Domino, Marisa Elena et al. (2006) Transitions between the public mental health system and jail for persons with severe mental illness: a Markov analysis. Health Econ 15:719-33
Cuddeback, Gary S; Morrissey, Joseph P; Meyer, Piper S (2006) How many assertive community treatment teams do we need? Psychiatr Serv 57:1803-6
Morrissey, Joseph P; Dalton, Kathleen M; Steadman, Henry J et al. (2006) Assessing gaps between policy and practice in Medicaid disenrollment of jail detainees with severe mental illness. Psychiatr Serv 57:803-8
Domino, Marisa Elena; Norton, Edward C; Morrissey, Joseph P et al. (2004) Cost shifting to jails after a change to managed mental health care. Health Serv Res 39:1379-401