Sunday, 16 January 2005 - 10:15 AM

This presentation is part of: Mental Health Service Utilization

Effects of Capitation on Outpatient Mental Health Episodes of Children

This study analyzed the effects of the Colorado Medicaid Capitation Program on the duration and services of over 21,000 outpatient mental health episodes for young children. Capitation was piloted in Colorado in 1994 with fourteen capitated Community Mental Health Centers (CMHCs). Three CMHCs remained fee-for-service during the initial pilot project, allowing for a quasi-experimental pre- post- design with non-equivalent comparison groups. This study of outpatient episodes spanned a three-year period before and after capitation was implemented, and compared episodes of outpatient care for children ages 0 – 11 from the managed care CMHCs with those from the CMHCs that remained fee-for-service. The purpose of the study was to better understand changes in patterns of care over the course of the implementation of capitation. Previous research showed that inpatient use and costs by children were reduced after capitation. The main hypothesis was that continuous outpatient episodes in the capitated sites would increase in duration, as CMHCs used Medicaid dollars more flexibly to provide alternatives to inpatient care. It was also hypothesized that capitated episode duration would increase for children who had been hospitalized and those diagnosed with disruptive disorders. Proportional hazards regressions revealed that capitation resulted in an increase in outpatient episode duration, over and above similar effects for the comparison fee-for-service episodes. The hypothesis that there were longer capitated episodes for children who were hospitalized was not supported. Children with behavioral and anxiety disorders showed increased episode duration compared to other diagnoses in the managed care sites. Service intensity as measured by the rate of services per month decreased over time in the managed care sites. Changes in case mix may have had an impact on changes in episode duration and service intensity. That outpatient episode duration increased over time while costs were lowered in the capitated agencies indicates some effects of capitation in changing patterns of care. This study was a first step in understanding the behavior of episodes of care for young children in the context of major system change such as capitation. The findings have implications for further research into the effects of managed care on patterns of services within episodes, and the interaction between episode duration and service patterns.

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