Managed care as a platform for cross-system integration.

Following the significant industrialization of private health care, managed care strategies for reducing costs are beginning to enter the public sector. Privatization of public mental health dollars is already a reality in some states and a growing possibility in many others. Changes in the financial management of behavioral health care are a source of concern for providers, advocates, and clients who desire services that are consistent with the core values of an integrated system of care. This article reviews the core values of the system of care for children and families, recent changes in the continuum of care for children with severe emotional disorders, and basic principles and strategies of managed care. It is proposed that system-of-care values and managed care principles are not mutually exclusive. In fact, a judicious combination of systems-of-care values and private sector management strategies may facilitate cross-system integration of services for children and youth. An example of a private, nonprofit corporation designed to manage public sector dollars across child welfare, juvenile justice, and mental health/alcohol and drug addiction systems is presented.