Reviews Tennessee's experience setting, monitoring, and updating capitation rates for Medicaid managed behavioral health care and draws lessons for other states. Finds that the initial behavioral health rate was inadequate, primarily because of the way available information was used, rather than...

A study recently published concluded that populations with different types of public health insurance have rates of receiving treatment for a substance use disorder that range from two to four times greater than the privately insured. The study was funded by the Substance Abuse and Mental Health...

With higher payments and expanded private-plan authority, Medicare Advantage (MA) has caused the market to grow. One in three Medicare beneficiaries with Part D now gets this coverage through MA. Analysis of the sources of and reasons for enrollment growth suggest a troubling report card....

Looks at the characteristics and responsibilities of organizations that mediate risk and care management responsibility between managed care organizations and individual providers, finding that some are experiencing serious financial problems.

The backlash against managed care has pressured plans to reexamine approaches to controlling utilization and managing members' health care needs, but how much has really changed? Interviews with health plans and others in 12 nationally representative markets suggest that the changes are significant.

Previous efforts by Congress to expand the role of private plans in Medicare have met with limited success. Although the same fate may befall Medicare Advantage, the political environment has changed, and powerful political interests now support Medicare privatization. Only time will tell...

Despite federal nursing home policies designed to prevent inappropriate institutionalization, many Medicaid beneficiaries under age 65 with serious mental illness may be inappropriately admitted to nursing facilities. A combination of the Medicaid policy requiring coverage for nursing home care...

The Medicare Part D coverage gap has been associated with lower adherence and drug utilization and higher discontinuation. Because osteoporosis has a relatively high prevalence among Medicare-eligible postmenopausal women, we examined changes in utilization of osteoporosis medications during...

For randomized controlled trials (RCTs) of education interventions, estimates of associations between student and mediating teacher practice outcomes can help examine the extent to which the data support the study's conceptual model. They can also identify mediators most associated with student...