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

Abstract

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.