The overall goal is the development of a fully capitated behavioral health system, which is clinically-driven, outcomes based and uses clear performance measures to evaluate system quality and consumer outcomes. The literature on managed care identifies four stages in managed care development. During this stage a utilization management system is frequently used, initial cost savings are realized in areas of over utilization and in reduction of high cost service utilization and data collection is established. The financing mechanism is most frequently fee-for service, but rate bundling, prior authorization and service limits are implemented. Capitation rates are refined and additional populations are phased in.
Data collection is adjusted and performance evaluation is based primarily on system outcomes.
System and consumer outcomes are identified and utilized in performance evaluation. States that have implemented managed care in public sector services are generally in Stage 1 or 2. A few who have been engaged in care management for several years are in Stage 3. It is helpful to evaluate West Virginia's efforts to implement a behavioral health managed care system in the context of these stages. Most of the work done to date relates to the developmental stage.