How to Ensure Quality Care in Medicaid
David Mechanic, Ph.D., in his presentation “The Changing Face of Mental Health Services: Is the Cup Half Empty or Half Full?” at APA's recent annual meeting, outlined major challenges in providing care to persons with serious mental illness (SMI).
He also posed a series of challenges to ensuring quality care through Medicaid programs, which are the major source of care for those with SMI.
Adequate care for those with SMI requires the following:
Providing and coordinating the essential elements of care. | |||||
Monitoring and assuring quality and accountability. | |||||
Promoting community integration and reduction of stigma. | |||||
Developing methods of managing “difficult/resistant clients” that address the problems of substance abuse comorbidity, treatment adherence, homelessness, and criminalization. | |||||
State Medicaid agencies need to take these actions:
Define the appropriate network of services. | |||||
Set a fair and realistic capitation level. | |||||
Establish norms for access, evidence-based treatment, intensity of care, patient satisfaction, and other relevant factors. | |||||
Ensure that data are collected that allow monitoring of performance. | |||||
Limit risk selection and cost-shifting by contracting agencies. | |||||
Define the risk arrangements for those agencies. | |||||
