Abstract

Editor's Note: In this article, which was first published in the March 1998 issue of Psychiatric Services, Dr. Geller and his coauthors describe how Massachusetts contracted with a private vendor in 1992 to manage behavioral health care for Medicaid beneficiaries. The vendor had a state network of 57 hospitals that agreed to accept a lower daily rate. Patients needing hospitalization could be sent up to 50 miles to an available bed. Data from 1992 to 1995 indicated that patients who were admitted to many different hospitals had longer lengths of stay than those admitted to hospitals where they were known. The authors describe the subset of patients who experienced discontinuity in treatment as a result of the managed care program. Objective: The study examined the characteristics of frequent users of inpatient treatment under public-sector managed care in Massachusetts between 1992 and 1995 and explored whether their pattern of inpatient utilization affected their overall use of hospital days. Methods: Individuals with five or more admissions in any of four fiscal years (1992 to 1995) were identified using the Massachusetts Department of Mental Health client tracking system. The demographic and clinical characteristics of these patients and the types of hospitals