To demonstrate cost‐effectiveness analysis (CEA) for evaluating different reimbursement models.
The CEA used an observational study comparing fee for service (FFS) versus capitation for Medicaid cases with severe mental illness (=522). Under capitation, services were provided either directly (direct capitation [DC]) by not‐for‐profit community mental health centers (CMHC), or in a joint venture between CMHCs and a for‐profit managed behavioral health organization (MBHO).
A nonparametric matching method (genetic matching) was used to identify those cases that minimized baseline differences across the groups. Quality‐adjusted life years (QALYs) were reported for each group. Incremental QALYs were valued at different thresholds for a QALY gained, and combined with cost estimates to plot cost‐effectiveness acceptability curves.
QALYs were similar across reimbursement models. Compared with FFS, the MBHO model had incremental costs of −$1,991 and the probability that this model was cost‐effective exceeded 0.90. The DC model had incremental costs of $4,694; the probability that this model was cost‐effective compared with FFS was <0.10.
A capitation model with a for‐profit element was more cost‐effective for Medicaid patients with severe mental illness than not‐for‐profit capitation or FFS models.
Data Sources/Study Setting