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...

The issue of risk selection is especially important for states that enroll blind and disabled beneficiaries of Supplemental Security Income (SSI) in Medicaid managed care. SSI beneficiaries have persistent needs for care, have a wide variety of chronic conditions, and often need atypical and...

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...

Data from two national telephone surveys of office-based primary care physicians are used to examine changes in patterns of care delivery between 1975 and 1979 in metropolitan and nonmetropolitan areas. Aspects of care delivery considered include physician availability, average physician...

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...