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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH054136-04
Application #
2460389
Study Section
Special Emphasis Panel (SRCM (04))
Project Start
1994-08-01
Project End
2000-07-31
Budget Start
1997-09-15
Budget End
2000-07-31
Support Year
4
Fiscal Year
1997
Total Cost
Indirect Cost
Name
University of California Berkeley
Department
Type
Schools of Public Health
DUNS #
094878337
City
Berkeley
State
CA
Country
United States
Zip Code
94704
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Morris, Anne; Bloom, Joan R; Kang, Soo (2007) Organizational and individual factors affecting consumer outcomes of care in mental health services. Adm Policy Ment Health 34:243-53
Kang, Soo Hyang; Wallace, Neal T; Hyun, Jenny K et al. (2007) Social networks and their relationship to mental health service use and expenditures among Medicaid beneficiaries. Psychiatr Serv 58:689-95
Morris, Anne; Bloom, Joan R (2002) Contextual factors affecting job satisfaction and organizational commitment in community mental health centers undergoing system changes in the financing of care. Ment Health Serv Res 4:71-83
Bloom, Joan R; Hu, Teh-Wei; Wallace, Neal et al. (2002) Mental health costs and access under alternative capitation systems in Colorado. Health Serv Res 37:315-40
Cuffel, Brian J; Bloom, Joan R; Wallace, Neal et al. (2002) Two-year outcomes of fee-for-service and capitated medicaid programs for people with severe mental illness. Health Serv Res 37:341-59
Cohen, E; Bloom, J R (2000) Managed care and service capacity development in a public mental health system. Adm Policy Ment Health 28:63-74