We propose a four year, multi-region, public-academic collaboration with the Colorado Division of Mental Health to evaluate the impact of their Medicaid capitation demonstration on the severely mentally ill (SMI). The importance of this proposal is highlighted by 1) the fact that Colorado has proposed a relatively pure form of risk based capitation and 2) sufficient diversity exists within the state to assess the effects of capitation on access and utilization for minority populations. Four capitated sites will be matched to an equal number of comparison sites based on ethnic mix of the SMI, rurality, and 'readiness for capitation.' Two independent measures of 'readiness' for capitation will be collected; one for matching sites and both can be used as control variables. A stratified random sample of 800 subjects will be evenly selected from capitation and comparison sites. Strata include ethnicity, gender, history of hospital use and the past year's service costs. Data will be collected on clinical outcomes, cost, and utilization. Primary data will be collected using the Brief Psychiatric Rating Scale, Quality of Life Interview, Global Assessment Scale, Colorado Client Assessment Record, client acculturation. Existing data from Colorado's Division of Mental Health and Medicaid will complement interview data. Measures of community programs' organizational structure and program operating style will be used to assess capitation's effects on innovation in mental health programming. Regression models will test the impact of capitation on client outcomes (access, utilization, 'appropriate' utilization, functioning and costs) and will also test for differential effects of capitation across gender and ethnic groups.
