Financing case management: making the money work.

Abstract

AbstractThe financing of case management for persons with chronic mental illness represents a particularly interesting and important challenge for the system of care.In promoting the goals of comprehensive case management, capitation payment systems offer some clear advantages over existing systems of reimbursement for units of service or episodes of care, which reinforce service fragmentation. Capitation, an integrative approach to funding the functions of case management within the context of all services, differs sharply from current fee‐for‐service approaches, which simply create new staff positions for “case managers.” There are, however, barriers to achieving a comprehensive prospectively funded case management model, which include inadequate data to project appropriate capitation rates accurately, vague standards of care for the chronically mentally ill, ongoing ambivalence about what levels of service effort and outcomes are acceptable, and a wide variety of resistances within existing service agencies. If these barriers can be overcome—a highly formidable task— then the mutually supportive concepts of comprehensive case management and capitation may lead to a far more cost‐effective system of care for chronic mental patients.