Two-year outcomes of fee-for-service and capitated medicaid programs for people with severe mental illness.

OBJECTIVE

To examine the effects of two models of capitation on the clinical outcomes of Medicaid beneficiaries in the state of Colorado.

DATA SOURCE

A large sample of adult, Medicaid beneficiaries with severe mental illness drawn from regions where capitation contracts were (1) awarded to local community mental health agencies (direct capitation), (2) awarded to a joint venture between local community mental health agencies and a large, private managed behavioral health organization, and (3) not awarded and care continued to be reimbursed on a fee-for-service basis.

STUDY DESIGN

The three samples were compared on treatment outcomes assessed over 2 years (total n = 591).

DATA COLLECTION METHODS

Study participants were interviewed by trained, clinical interviewers using a standardized protocol consisting of the GAF, BPRS, QOLI, and CAGE.

PRINCIPAL FINDINGS

Outcomes were comparable across most outcome measures. When outcome diffrences were evident, they tended to favor the capitation samples.

CONCLUSIONS

Medicaid capitation in Colorado does not appear to have negatively affected the outcomes of people with severe mental illness during the first 2 years of the program. Furthermore, the type of capitation model was unrelated to outcomes in this study.