Implementing Managed Care for Substance Abuse Treatment Services: Process and Staff Perspectives

Abstract

When introducing managed care to publicly funded substance abuse treatment systems, most state and local authorities contract with private behavioral health managed care companies. We examine the organizational changes that result when a California county chooses to manage internally its own care. We relied on three sources of data: County documents, transcripts of informational meetings between researchers and county representatives, and interviews with 22 staff members at 6 substance abuse treatment centers. Interviewees reported satisfaction with more equitable access to treatment for clients and greater accountability among providers, but many were dissatisfied with increased caseloads and paperwork. Our results reveal that internally managed care in public sector substance abuse treatment systems shares many similarities with managed care delivered by a managed care organization. Both introduce an additional layer of bureaucracy that can frustrate staff. Addressing publicly-valued goals such as equity and comprehensive care may be best achieved by creating systems of care that combine the efficiency orientation of the private sector with the equity orientation of the public sector.