Beyond the Water's Edge: Charting the Course of Managed Care for People with Disabilities - Conference Resource Book. Colorado's Early and Preliminary Experience with Capitation for the Severely and Persistently Mentally Ill Adults

11/01/1996

Joan R. Bloom, Ph.D.
Joan Bloom is Professor of Health Policy and Administration at the University of California, Berkeley in the School of Public Health. She received her doctorate in Sociology of Education at Stanford University. She is a Co-Investigator at the Center for Mental Health Services Research. In addition, she is an Affiliated Investigator at the Northern California Cancer Center and a Consultant for the Stanford University Medical Center. Her research interests include organizational studies and community services focused on the delivery of medical and mental health services. She has had a long-standing interest in prevention and early detection of chronic disease. She is currently the Principal Investigator of two NIH funded studies: (1) the Colorado Capitation Study in which mental health services are being capitated for the Medicaid eligible population in the State of Colorado funded by the National Institute of Mental Health; and (2) Young Women with Breast Cancer, funded by the National Cancer Institute in which ethnically diverse, newly diagnosed younger women in the greater Bay Area are assessed and provided with a psychosocial support intervention. She is also involved in a longitudinal study focused on work redesign of hospital nurses. She serves on the Board of Directors of the Northern California Cancer Center and on the editorial boards of Cancer Prevention, Epidemiology and Biomarkers and International Journal of PsychoOncology. She serves on the Breast and Cervical Cancer Advisory Committee for the State of California and is Chair of their Evaluation Committee.

Dr. Bloom's teaching interests include organizational sociology, health care management, and program planning and evaluation. She teaches courses in program planning and evaluation, and master and doctoral level courses in organizational studies plus a variety of seminars.

RESEARCHERS

  • University of California, Berkeley
    • Joan R. Bloom, Ph.D.
    • Teh-wei Hu, Ph.D.
    • Jaclyn W. Hausman, M.P.H., M.P.P.
    • Neal Wallace, M.P.A.
    • Richard Scheffler, Ph.D.
  • MEDSTAT, Washington, DC
    • Brian Cuffel, Ph.D.

COLORADO'S MENTAL HEALTH SYSTEM

  • Seventeen Community Mental Health Centers (CMHCs) provide the majority of outpatient services.
  • Two state hospitals provide short and long term psychiatric services.
  • Additional emergency services are provided in private facilities.

FEATURES OF CAPITATION PROGRAM

  • Pilot program.
  • Fully capitated--inpatient and outpatient.
  • Carve-out.
  • Covers all Medicaid beneficiaries needing mental health services.
  • August/September 1995 program began.

SPECIFIC AIMS:

  • Consumer Outcomes:
    • Do consumer outcomes differ?
  • Access and Utilization:
    • Does access and utilization of mental health services change?
  • Cost:
    • Does the cost of services differ?
  • Cost-Effectiveness:
    • Does cost-effectiveness differ?
  • Implementation and Innovation:
    • Does capitation facilitate innovation in public mental health systems?

SUBJECT CHARACTERISTICS

  • Medicaid Eligible
  • Gender (50% female, 50% male)
  • Diagnosis:
    • Schizophrenia OR
    • Bipolar Affective Disorder OR
    • Any diagnosis and 24-hour care episode in previous year
  • Cost (High cost/Low cost)*

*Only for 1994 sample

ORGANIZATIONAL CHANGE MEASURES:

  • Community Program Philosophy Scale
  • Organizational Culture Questionnaire
  • Organizational Structure Survey
  • Key Informant Interviews
TABLE 1. Research Design
Targets for Each Cell 1994 1995 New to System
Model 1* 128 64 64
Model 2* 128 64 64
Comparison - FFS 128 64 64
Model 1 = Stand Alone/Alliance CMHC
Model 2 = Joint venture between FP managed care firm and Stand Alone/Alliance CMHC

 

TABLE 2. Status of Consumer Interviews: 9/1/96
  Wave 1
(Baseline)
Wave 2 Wave 3
Completed Interviews 684 521 232
Refused 116 13 3
Deceased n/a 5 4
Unable to Locate 53 11 1
Non-Response 35 7 0
Too Ill 7 3 3
Contacted to Date 895* 560 243
Success Rate 76% 93% 95%
* An additional 361 individuals were assigned for a total of 1265, however, these potential subjects were deemed inappropriate for a variety of administrative and clinical reasons.

 

TABLE 3. Socio-Demographic Characteristics of Sample for Each Group
Characteristic Model I
(%)
Model II
(%)
F.F.S.
(%)
Gender
   Male
   Female
 
48.5
51.5
 
49.4
50.6
 
47.9
52.1
Ethnicity
   White
   Black
   Hispanic
 
67.7
4.0
6.1
 
46.9
4.9
19.8
 
45.8
18.8
8.3
Age
   21-35
   36-50
   51-65
   65+
 
43.4
41.4
13.1
2.0
 
25.9
46.9
19.8
7.4
 
31.9
53.2
6.4
8.5
Diagnosis
   Schizophrenic
   Bipolar-Affective Disorder
   Other
     
High Cost Client 31.3 39.5 52.1

 

TABLE 4. Utilization of Mental Health Services for Each Model Before and Following Implementation of Capitation*
Characteristic Model I Model II FFS
Pre- Post- Pre- Post- Pre- Post-
Inpatient
Outpatient
Day Treatment
Crisis Intervention
Individual Therapy
Group Therapy
Case Management
           
* 6 months prior to six months following capitation as of November 1996.

 

TABLE 5. Costs Per Unit of Payment (Mean and Variance) for Mental Health Services for Each Model Before and Following Implementation of Capitation*
Characteristic Model I Model II FFS
Pre- Post- Pre- Post- Pre- Post-
Inpatient
Outpatient
Day Treatment
Adult Treatment
Crisis Intervention
Individual Therapy
Group Therapy
Case Management
Total Costs
           
* 6 months prior to six months following capitation as of November 1996.

 

TABLE 6. Outcomes of Mental Health Services for Each Model Six Months Before and Six Months Following Implementation of Capitation*
Characteristic Model I Model II FFS
Pre- Post- Pre- Post- Pre- Post-
Health Status
   (MOS SF36)
   Physical Functioning
   Bodily Pain
   General Health
   Social Functioning
   Mental Health
           
Mental Health
   Symptoms (BPRS)
           
Functional Status
   GAF Score
   Family Contact
   Daily Activity
   Social Contact
           
Quality of Life
   Ever Homeless
   Housing Adequacy
           
Finances
   Self-reported Income
   Income Adequacy
   Average Adequacy
           
* Results as of November 1996.

 

 

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