The impact of the Massachusetts Managed Mental Health/Substance Abuse Program on outpatient mental health clinics.

Medicaid managed care initiatives pose special challenges to outpatient providers. During the first two full years of the Massachusetts Mental Health/Substance Abuse initiative, an analysis of cost and utilization data showed that outpatient mental health utilization and expenditures dropped slightly, although far less than did expenditures and utilization for inpatient facilities. In a telephone survey of a stratified random sample of outpatient providers, they reported that access, appropriate 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 toward more emphasis on group and family care and brief therapies. As organizations, they made substantial operational changes. As a result, some agencies did better, while others did worse, under this new system.