THE IMPACT OF THE MASSACHUSETTS MANAGED MENTAL HEALTH SUBSTANCE ABUSEPROGRAM ON OUTPATIENT MENTAL-HEALTH CLINICS/

Medicaid managed care initiatives pose special challenges to outpatien t providers. During the first two full years of the Massachusetts Ment al Health/Substance Abuse initiative, an analysis of cost and utilizat ion data showed that outpatient mental health utilization and expendit ures dropped slightly, although far less than did expenditures and uti lization for inpatient facilities. In a telephone survey of a stratifi ed random sample of outpatient providers, they reported that access, a ppropriate utilization, quality of care, the severity of their clients and aftercare coordination increased, while length of stay for these clients decreased. In their clinical practices, agencies shifted towar d more emphasis on group and family care and brief therapies. As organ izations, they made substantial operational changes. As a result, some agencies did better, while others did worse, under this new system.