Case Study: A Medicaid Health Maintenance Organization Quality Initiative for Behavioral Health

Abstract

The purpose of this case study is to assess a Medicaid health maintenance organization quality initiative designed to screen new members for behavioral health treatment needs on enrollment. New members were screened by the health maintenance organization, which then informed the for-profit managed care organization responsible for the management of the mental health and substance abuse benefit of its findings. Other than the screening, there were no contractual expectations. The managed care organization was given only the names of individuals who “screened positive,” but was not required to act on the screening results. Twenty percent of newly enrolled Medicaid health maintenance organization members were screened, and 2.5% were identified to have behavioral health and substance abuse treatment needs. As Medicaid managed care is responsible for the health care of low-income beneficiaries who are inherently vulnerable, it is important to make every effort to evaluate the impact of a quality project meant to improve their treatment.