Six-month outcomes of an integrated assertive community treatment (ACT) team serving homeless adults with co-occurring substance use and mental health disorders

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Developed by a multi-institutional group of collaborators with participation of an expert panel, this instrument can characterize public sector managed behavioral health care arrangements, capturing key differences between managed and "unmanaged" care and among managed care arrangements. To successfully capture data regarding access, service utilization, costs, and quality, characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability were assigned to individual domains. Data was collected at the level of the managed care organization, the subcontractor, and the network of service providers through contract abstraction and key informant interviews. A multilevel coding scheme was used to organize the data into a matrix along key domains, which was then reviewed and verified by the key informants. The analysis suggests that this instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Besides documenting basic features of the plans and providing contextual information, data gathered by this instrument will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care.

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