Monitoring Behavioral Health Service Reform in the Age of Managed Care: A Qualitative Study of New York State's Regional Planning Consortiums

Background:

This study uses qualitative methods to examine an important innovation in behavioral health service planning. New York State recently began a major initiative to overhaul its behavioral health payment and delivery systems. Under a newly minted Medicaid waiver program, the state will integrate behavioral and primary health care, carve behavioral health services into comprehensive managed care, and replace fee-for-service with value-based payments. As a component of this initiative, policymakers have endorsed the value of a regional planning approach. Ten Regional Planning Consortiums (RPCs) will monitor the state’s managed care transition, bringing together local stakeholders—including peers and family members, community based organizations, hospitals and health systems, local government officials, and managed care organizations—to provide input into the planning process. RPCs will implement a collaborative governance model to improve behavioral health care through consensus building and local participation. This study asks two related questions. How do leading behavioral health officials understand the challenges of managed care reform? And, how do they believe RPCs will respond to these challenges?

Methods:

Data were collected using snowball sampling to recruit key informants who played a central role in developing New York State’s RPC model. I interviewed 20 behavioral health officials, including 10 Directors of Community Services from a diverse range of urban and rural counties, seven state officials from the Office of Mental Health and Office of Alcoholism and Substance Abuse, and three staff from the Conference of Local Mental Hygiene Directors. Officials represented the highest levels of state and county behavioral health authority in New York State. Semi-structured interviews involved a managed verbal exchange in which I began with structured questions, listened attentively, and encouraged participants to generate their own insights. Qualitative data were coded systematically with NVivo. I used grounded theory to group related concepts, develop categories of meaning, and build confirming and disconfirming evidence of key constructs.

Results:

State and county officials identified three categories of concern for the behavioral health managed care transition. They worried that the profit motive and financial incentives inherent in managed care would ration services away from the most socially vulnerable, that behavioral health expertise and specialization would be lost under centralization and privatization of authority, and that rural areas would be particularly negatively impacted by gaps in network adequacy. Officials reported that RPCs may help to mitigate these threats by providing local accountability and oversight, promoting inclusiveness, collaboration, and broad stakeholder voice, and creating a meaningful role for regional involvement to facilitate coordination and planning.

Implications:

Collaborative governance provides a model of stakeholder involvement that aligns with the goal of distributive justice that informs social work scholarship. As a major component of New York State’s managed care transformation, RPCs will hold important lessons for behavioral health scholars, policymakers, and providers. Findings from this study may influence leaders in other states that will look to New York’s RPC model as an example for developing accountability strategies, monitoring regional impact, and including stakeholder voice in behavioral health service planning.