Person -centered care program philosophy in capitated community mental health centers in Colorado.

摘要

Research objective. This study seeks to understand the relationship between person-centered care (PCC) program philosophy and capitated financing arrangements in community mental health centers (CMHCs) and how organization-level PCC program philosophy is associated with individual-level service utilization, expenditures, and clinical outcomes.;Study design. Fourteen CMHCs in Colorado were capitated using two models---a direct capitation (DC) model with non-profit managed care organizations or a joint-venture model with a for-profit managed behavioral health organization (MBHO). Three CMHCs remained fee-for-service (FFS). Data is collected one year pre-capitation and two years post-capitation on 522 individuals with severe and persistent mental illness. The PCC program philosophy scale encompasses four subscales: family involvement and orientation; addressing the multiple needs of severely mentally ill consumers; individualized care; and user education and advocacy. Generalized estimating equation models were used to assess the relationship between organizational PCC and service utilization, expenditures, and clinical outcomes.;Principal findings. DC model CMHCs had PCC program philosophy scores that were higher than their FFS and MBHO counterparts. Mean organizational PCC program philosophy was not significantly associated with service utilization. In capitated CMHCs, PCC program philosophy was negatively related to outpatient service utilization. PCC program philosophy was negatively associated with local and state hospital expenditures. In capitated CMHCs, PCC program philosophy was positively related to state hospital expenditures. PCC program philosophy was positively associated with global functioning and negatively associated with psychiatric symptoms. In capitated CMHCs, the reverse relationship was found.;Conclusions. Differential PCC program philosophy scores between DC and MBHO model CMHCs suggest organizational influence arising from profit-status. While not associated with the probability of service utilization, PCC program philosophy may be associated with the provision of supportive services that allow for shorter hospital stays. Within capitated CMHCs, PCC program philosophy may attenuate the negative incentive to decrease service intensity. Findings also reflect initial service utilization and expenditure differences present in CMHCs prior to capitation. Organizations with higher mean PCC program philosophy were associated with higher global functioning and lower psychiatric symptoms in their clients. Within capitated CMHCs, organizational PCC program philosophy reflected responsiveness to clients with greater psychiatric and functioning needs.