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Although Medicaid is the largest public payer of behavioral health services, information on access and utilization of services is lacking, and no data on the frequency of service use or types of services provided for children with autism spectrum disorders (ASDs) are available. As states move toward managed care approaches for their Medicaid program, services information is critical. Behavioral health service data for children with autism spectrum disorders were collected from a state Medicaid Managed Care (MMC) program and analyzed from fiscal years 1995 through 2000. Findings revealed that the number of children who received services over time increased significantly; however, the rate of service use was only one tenth of what should be expected based on prevalence rates. The mean number of service days provided per child decreased significantly, about 40%, and the most prevalent forms of treatment changed. Day treatment vanished and medication and case management increased disproportionately to the number of children served. Explanations and implications of the findings are presented as well as recommendations for future research.

Objective: This study assessed trends in access to and use of behavioral health services for school-aged children in TennCare, Tennessee's Medicaid managed care program, between state fiscal years 1995 and 2000., Methods: Claims, encounter, and enrollment data from the Bureau of TennCare were used. The data analyzed were restricted to services and enrollment periods for children and adolescents between the ages of four and 17 years at the time of service or enrollment. Measures were calculated in four areas: overall access to behavioral health services, use of inpatient services, use of outpatient specialty treatment services, and use of supportive services like case management and medication management., Results: The number of youths who received a behavioral service increased by nearly 50 percent between state fiscal years 1995 and 2000. At the same time, the number of youths enrolled in TennCare increased by 19 percent. The annual access rate increased from 72.7 youths per 1000 enrollees to 91.7. However, the volume of services for children fell. Access rates were low relative to estimates of need in this population. The system made less use of inpatient services and relied more on outpatient services, particularly case management and medication management services., Conclusions: Children's access rates for behavioral health services improved even as the TennCare program expanded to cover more children. The system served more youths in part by reducing the volume of services for children receiving treatment and substituting more supportive services. Ongoing performance monitoring for policy making will require enhancements of data monitoring activities by the state.

Managed care is the current state of health care delivery. How to respond to managed care's provider expectations is the key issue for all mental health care professionals. The adaptive response, based on managed care's definition of value and regardless of theoretic orientation, must be clear and definitive in terms of what the provider will do; why the provider will do it; how the provider will specifically achieve patient relief; and how the provider, patient, and managed care representative will know when that change has been achieved. In the managed care era, clinicians must satisfy patients, managed care representatives, and themselves by producing a valid and effective treatment product for all parties involved in the interplay of mental health care delivery.

A wide gap exists in the American health care system between what we know good geriatric mental health care services should look like and the types of services generally available. Cost effective treatment requires a continuum of care in which geriatric psychiatry and primary care geriatric services are integrated in an aggressively case managed model. MCOs have the infrastructure and tools at their disposal to make this work, but they must incorporate into their programs and approaches expert knowledge of the unique clinical problems of the frail elderly.

There is a public discussion in Politics and Health services whether managed care should be realized in Germany. The German Medical Services of the Statutory Health Insurance (MDK) are also involved and have great interest and an opinion about this topic because the introduction of managed care or elements of managed care will influence the cooperation between the MDK and the German Statutory Health Insurance. The following article informs on certain elements of managed care already practised in Germany and discusses which of these elements can be used more intensively in the future according to Social Laws and developed structures.

Case management has become a commonly used tool in the age of managed care. Case management is especially valuable when combined with demand management, disease management, and computerized information systems. This article presents a model that outlines each of these within the continuum of care.