Managed Behavioral Health in the Public Sector

Two articles in this issue explore states' use of managed behavioral health care. Dr. Michael Hoge and his colleagues (page 51) present a valuable paper identifying ten critical variables that offer an important focus for planning and evaluating programs designed to provide behavioral health care to those whose needs are met in the public sector. Drs. James Sabin and Norman Daniels (page 39) describe some important aspects of Massachusetts' behavioral health care program, which is jointly administered by my agency and the state's Department of Mental Health. Their article outlines the evolution of the program, from a principal concern with cost containment to greater emphasis on improved quality.

I would add only a few points to the excellent contributions these articles make to an understanding of the dynamics and imperatives of managed behavioral health care for vulnerable populations.

First, Massachusetts has accomplished several important goals by combining the behavioral health funding from our state's Medicaid and mental health agencies into one system and by having our two agencies jointly manage the contract with the vendor. We have reduced fragmentation of services, given uninsured people access to the same network of inpatient providers that serve the insured population, and generated tens of millions of dollars of savings. Those savings have enabled the Department of Mental Health to reinvest in community programs and have contributed to our state's ability to expand Medicaid coverage to what will soon be 300,000 more people.

Second, stakeholders' involvement is a vital component of our program. The input of consumers, their family members, providers, advocates, and others is eagerly solicited—not only through formal structures such as advisory councils and public forums but through many informal mechanisms as well. Stakeholders' opinions and observations are important elements in our evaluation of our contractor's performance as well as in the decisions of our two agencies and the contractor about priorities and program changes.

And finally, a point that both articles allude to but that bears repeating: the keys to achieving quality—in behavioral health as elsewhere—are defined quality standards and purchasers' commitment to using those standards to improve quality. Defining quality in behavioral health is in its infancy. Much more has to be done. It is the responsibility of everyone involved—purchasers, providers, advocates, and beneficiaries—to make certain that meaningful, measurable standards are adopted and used so that the great potential of managed care to improve quality of care will be fully realized.—