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Rethinking Care for Medicaid Beneficiaries with Co-Occurring Physical and Behavioral Health Conditions

The Rethinking Care Program, an initiative of the Center for Health Care Strategies (CHCS), seeks to improve the quality and lower the costs of care for high-need, high-cost Medicaid beneficiaries. In 2008, the Pennsylvania Department of Public Welfare and CHCS launched two pilot programs under this initiative, focusing on the integration of physical and behavioral health care services for adult Medicaid beneficiaries with serious mental illness and co-occurring physical health conditions.

The initiative links state pilot demonstrations with a national learning network dedicated to improving Medicaid's capacity to serve this population. The program in Southeast Pennsylvania is a community-based partnership between the behavioral health agencies in Bucks, Montgomery, and Delaware counties; Magellan Behavioral Health; and the Keystone Mercy Health Plan. Partners for the program operating in Allegheny County in Southwest Pennsylvania include UPMC for You, a nonprofit Medicaid managed care plan; Community Care Behavioral Health, a nonprofit behavioral health managed care organization; and the Allegheny County Department of Human Services.

Mathematica is conducting an implementation analysis and descriptive analysis of outcome measures constructed from Medicaid claims data. The evaluation’s primary objectives are to:

• Provide detailed descriptions of each pilot site’s structure, roles of key stakeholders, and implementation activities
• Assess the effectiveness of implementation in each site, using both qualitative and quantitative methods
• Compare implementation strategies and their relative effectiveness across the sites to discern if and how different environments shape implementation and impacts
• Provide a formative evaluation to support the continuation of efforts in Pennsylvania and future pilots in other states

Interim results are expected in spring 2011.