Volume Three: Designing Substance Abuse and Mental Health Capitation Projects: A Managed Care Guide for State and Local Officials

• NCJ Number: 189873
• Author(s): Cindy Brach MPP
• Date Published: 1998
• Length: 67 pages
• Sponsoring Agency: Substance Abuse and Mental Health Services Admin (SAMHSA)
• Sale Source: SAMHSA's National Clearinghouse for Alcohol and Drug Information; NCJRS Photocopy Services
• Publication Format: Document
• Publication Type: Report (Technical Assistance)
• Language: English
• Country: United States of America
• Note: This volume is part of the Managed Care Technical Assistance Series

Annotation

The capitation or managed care guide was intended to assist State and local officials in the design of substance abuse and mental health projects utilizing an alternative means of financing treatment, capitation.

Abstract

The financing mechanism known as capitation is being used with increasing frequency in the substance abuse and mental health fields as an alternative means of financing treatment. Capitation is a prospective, per-enrollee method of payment for a defined set of services. This guide drew more heavily on examples from mental health capitation projects than substance abuse capitation projects. In addition, the guide focused on capitation and how it differs from the traditional mechanisms for funding substance abuse and mental health treatment. Part I of the guide defined capitation and its goals and discussed the pros and cons of using capitation to improve the current delivery system. Capitation project goals consisted of: reducing service, fragmentation, increasing access, and improving accountability; containing costs; decreasing hospitalization and expanding or developing community services; and opportunities for innovation and changing patterns of service delivery. It also described the theoretical arguments used by proponents and opponents. Part II examined each decision facing designers of capitated projects by detailing the practicalities involved in each step. Ten steps were identified in the implementation of a capitation plan: (1) identify goals; (2) define population eligible for enrollment; (3) determine the scope of services; (4) assign responsibilities for administration and delivery; (5) contracting; (6) manage risk; (7) set payment rates; (8) market and enroll clients; (9) ensure quality; and (10) implement project. Experiences of States and counties that implemented capitation projects were discussed Experiences with capitation projects primarily in the mental health field have shown that they can achieve cost savings. Capitation’s straightforward appearance as a financing mechanism, simply paying a fixed price up front for any needed services, contradicts its complexity. Selected bibliography, telephone interviews, and decision checklist