G2TT
来源类型Report
规范类型报告
DOIhttps://doi.org/10.7249/RRA1517-1
来源IDRR-A1517-1
Carve-In Models for Specialty Behavioral Health Services in Medicaid: Lessons for the State of California
Marcela Horvitz-Lennon; Jonathan S. Levin; Joshua Breslau; Jonah Kushner; Nicole K. Eberhart; Mallika Bhandarkar
发表日期2022-02-11
出版年2022
页码42
语种英语
结论

Evidence on the carve-in model's impacts is surprisingly limited

  • A review of the research literature uncovered only three rigorous studies.
  • Although this evidence suggests some potential benefits for carve-ins, its generalizability to California is uncertain because of differences between the policy contexts.

However, a review of the qualitative evidence and key informant interviews generated valuable evidence

  • Carve-in does not necessarily result in financial, organizational, or clinical integration, or expected outcomes.
  • Carve-in states have taken additional regulatory actions to promote organizational and clinical integration, and other expected outcomes.
  • Carve-in states have used other approaches to mitigate potential risks of the carve-in model.
  • Carve-in implementation requires an incremental, stakeholder-engaged process.

The expected benefits of carve-in models can be achieved in a carve-out environment

  • Carve-in and carve-out models can have comparable performance if designed to both facilitate their expected benefits and minimize their potential risks.
  • Whereas the carve-in model's main expected benefit is clinical integration and its main potential risk is adverse selection, the carve-out model's main expected benefit is adequate access to specialty behavioral health care and its main potential risk is inadequate access to physical health care/poorer physical health outcomes.
  • Design considerations are more important than the decision to finance behavioral health services as a carve-in versus carve-out, with key design features including contracts and data analytics, payment, and regulations and administrative processes.
  • States can use additional approaches — including screening, navigators, colocation, and health homes — to reduce care fragmentation and improve integration, regardless of the behavioral health financing model.
摘要

Many states separate, or "carve out," Medicaid financing of behavioral health services from financing for other types of health care, but there has been a recent trend in some states toward "carve-ins," whereby financing for behavioral health services is combined with the larger pool of Medicaid-covered services. This trend has been driven by evidence that strategies to enhance clinical integration of behavioral and physical health care can improve physical health care outcomes for individuals with serious mental illnesses.

,

California's Medi-Cal system uses a carve-out approach to finance specialty behavioral health services for enrollees with serious mental illnesses and/or substance use disorders, but the state has planned to pilot carve-in contracts as part of a broad reform of Medicaid delivery and payment. To inform the policy discussion, the authors of this report examined other states' experiences with carve-ins, the evidence on the impacts of this approach, and the implications for California.

目录 Carve-In Models for Specialty Behavioral Health Services in Medicaid: Lessons for the State of California | RAND ">
主题California ; Health Care Access ; Health Care Payment Approaches ; Health Care Quality ; Health Care Reform ; Medicaid ; Mental Health and Illness ; Substance Use Disorders
URLhttps://www.rand.org/pubs/research_reports/RRA1517-1.html
来源智库RAND Corporation (United States)
引用统计
资源类型智库出版物
条目标识符http://119.78.100.153/handle/2XGU8XDN/524709
推荐引用方式
GB/T 7714
Marcela Horvitz-Lennon,Jonathan S. Levin,Joshua Breslau,et al. Carve-In Models for Specialty Behavioral Health Services in Medicaid: Lessons for the State of California. 2022.
条目包含的文件
文件名称/大小 资源类型 版本类型 开放类型 使用许可
RAND_RRA1517-1.pdf(411KB)智库出版物 限制开放CC BY-NC-SA浏览
x1644586684240.jpg.p(4KB)智库出版物 限制开放CC BY-NC-SA浏览
个性服务
推荐该条目
保存到收藏夹
导出为Endnote文件
谷歌学术
谷歌学术中相似的文章
[Marcela Horvitz-Lennon]的文章
[Jonathan S. Levin]的文章
[Joshua Breslau]的文章
百度学术
百度学术中相似的文章
[Marcela Horvitz-Lennon]的文章
[Jonathan S. Levin]的文章
[Joshua Breslau]的文章
必应学术
必应学术中相似的文章
[Marcela Horvitz-Lennon]的文章
[Jonathan S. Levin]的文章
[Joshua Breslau]的文章
相关权益政策
暂无数据
收藏/分享
文件名: RAND_RRA1517-1.pdf
格式: Adobe PDF
文件名: x1644586684240.jpg.pagespeed.ic.3NJsI627Mz.jpg
格式: JPEG

除非特别说明,本系统中所有内容都受版权保护,并保留所有权利。