Evaluation of Prepaid Mental Health Plan at Rockland Psychiatric Center

Evaluation of the Prepaid Mental Health Plan at Rockland Psychiatric Center

Investigators: Judith Samuels, Ph.D., Kim Hopper, Ph.D., Carole Siegel, Ph.D., and Maureen Clavel

PROJECT GOALS

New York State has encouraged outpatient programs at state hospitals to change from categorical programming to individualized services within a managed care framework. Along with service changes, the state has converted payments to state facilities to partial capitation payments. As a result Prepaid Mental Health Plans (PMHPs) have recently been implemented at each state-operated psychiatric center. Rockland Psychiatric Center, a state psychiatric hospital serving recipients in Rockland and southern Westchester counties, has converted its outpatient services to PMHPs and has incorporated many managed care concepts in a new service delivery model, offering a menu of mental health services at seven locations within Rockland and Westchester counties.

The Rockland Psychiatric Center Community Service staff and the Center are conducting a collaborative study to examine the impact of the new service system on recipients and their families. The study will describe each program and its stated intent and assess implementation fidelity to shed light on the integration of managed care principles into the delivery of community-based public mental health services. The study will include analysis of the impact of the PMHPs on consumer and staff outcomes.

RESEARCH ACTIVITIES AND RESULTS

Implementation of the study began in September, 1996 when a field research team was hired and trained. Data are collected quarterly in each of three areas: quantitative measures of "high user" outcomes, in-depth structured interviews with small numbers of consumers, and interviews and focus groups with staff. Data collection was completed in July 1997.

Although the conceptual framework for the PMHP program is based on managed care concepts, implementation of the new program has been concurrent with large staff reductions (averaging 40 percent staff at PMHP locations). These two parallel developments are making it difficult to parse out the individual effects attributed to the managed care changes, so that the results of this study will reflect both a shift to using managed care techniques for providing outpatient services and a down-sizing effort by program administrators.

Periodic reports on preliminary study findings, shared with PMHP administrators, suggest minimal impact of the programmatic change on such consumer outcomes as hospitalization rates. However, the implementation of the PMHP appears to have had a significant impact on program staff, who express great dissatisfaction with their new job titles, responsibilities and increased caseloads.

SIGNIFICANCE OF FINDINGS/POLICY IMPLICATIONS

As managed care organizations begin to enroll individuals with severe mental illness, defining an appropriate and effective service model is important. By studying the impact of four different service models, or service packages, operating within a single system, this project will result in findings that can be used in the process of formulating public policies and professional standards for the care of individuals with severe mental illness enrolled in managed care programs. Results will speak as well to the problem of monitoring staff morale in a climate of severe reduction in workforce and perceived "de-skilling" of professional positions.

PLANS

Data analysis is proceeding.

Updated: April 12, 1999

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