Managed Health Care Approaches Title: Issues and approaches in evaluating

Authors: Wells, Kenneth B.; Astrachan, Boris M.; Tischler, Gary L.

Citation: The Milbank Quarterly, Spring 1995 v73 n1 p57(19)

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Subjects: Psychiatric services_Management

Managed care plans (Medical care)_Evaluation

Health services administration_Evaluation

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Author's Abstract: COPYRIGHT Milbank Memorial Fund 1995

Data on the ways in which alternative forms of managed care affect the costs, quality, and outcomes of mental health are needed to inform health policy and clinical care decisions. Such evaluations, however, are difficult to implement for conceptual and practical reasons. The definition of managed mental health care is reviewed, alternative forms are described, and the activities and procedures that constitute managed care are identified. Examples from existing studies are used to describe the common roadblocks to implementing evaluations and to suggest methods for dealing with these barriers.

Full Text COPYRIGHT Milbank Memorial Fund 1995

Managed health care is rapidly becoming the backbone of health care delivery in the United States (Sederer and Clair 1989; Ellwood 1988). Yet little is known about its effects on access, quality, and outcomes (Tarlov et

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anging environment. Businesses are rarely interested in carrying out experimental designs because of the disruption to their routines. Further, because companies need to remain profitable and competitive, there is often little time to develop, fund, and complete the process before changes are made in benefits or service delivery programs that may weaken the evaluation of a managed care activity. Turnover in top-level management may result in loss of support for the research project. Companies may feel pressured to obtain results quickly, thereby limiting the range of complexity of the studies that can be conducted. Third, currently available data sets on managed care are limited. For example, in the area of claims data, problems can occur when data are missing, or when formats for inputting information are changed - often without documentation - so that the data on further claims do not include information on out-of-plan use, as, for example, when patients turn to public mental health services after benefits are exhausted. This requires researchers to evaluate carefully the strengths and limitations of each data source, but often they do not discover the major limitations of data sets until a good deal of work has been done on
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Some common words found in the essay are:
Care Managed, Stewart Ware, Curtis Rice, Interview Schedule, Care Research, IPAs MOS, Medicare's PPS, Source Adapted, PPO Luft, Institute Medicine, managed care, mental health, health care, et al, mental health care, managed mental health, managed mental, quality care, health services, medical care, service delivery, data sets, mental health services, medical outcomes study, mental health specialty,
Approximate Word count = 6285
Approximate Pages = 25 (250 words per page)

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