Four examples of students at Mount Holyoke who had pursued this goal well before the founding of the MHMA
are Charlotte Bailey, who left in 1838 to work in Africa; Fidelia Fiske, who in 1843 went to Persia to start Fiske Seminary for girls; and two nieces of Mary Lyon (the founder of Mount Holyoke Female Seminary), graduates of 1838 and 1840, who both taught at Mount Holyoke before marrying and then departing for India and China.
As part of the demonstration waiver from the Health Care Financing Administration, DMA was required to conduct an independent evaluation of MHMA's first year to ensure that overall access, quality, and cost effectiveness of care were enhanced or maintained rather than diminished by the carve out.
(1996) reported reductions in access to both inpatient and outpatient substance abuse services in Massachusetts over the first two and a half years of MHMA, with a corresponding increase in the use of some new, intermidiate services (partial hospitalization, acute residential treatment, etc.).
Some critics maintain that this arrangement creates an undesirable incentive for MHMA to refuse to authorize treatment to disabled clients in an effort to contain costs.
It extends the work of researchers at Brandeis and elsewhere to cover the complete time frame of MHMA, provides comprehensive penetration rates that measure access both within and across types of services, and standardizes penetration and spending rates for the increasing proportion of disabled clients.
Claims were matched by the recipient's historic number (the permanent ID number) in eligibility files to obtain demographic characteristics, Medicaid eligibility category, and enrollment status in MHMA at the time of the claim.
Overall access was evaluated by comparing the penetration rate (the rate of unduplicated users of MH/SA treatment per 1,000 MHMA enrollees) for the year prior to (FY 1992) and the years following the carve out (FY 1993 to FY 1996).
This adjustment was needed because the number of disabled MHMA enrollees increased by 29 percent from 1992 to 1996 even though overall MHMA enrollment grew only 2 percent over this period (see Table 1).
These figures suggest that MHMA constrained costs by encouraging treatment in less costly nonmedical facilities and discouraged treatment in hospitals.
During the first four years of the managed behavioral health care carve out for Massachusetts Medicaid enrollees MHMA both achieved and maintained (but did not augment) spending reductions on substance abuse treatment while improving overall access, particularly for disabled enrollees.
Financial incentives in the contract between DMA and MHMA may have played a role in ensuring that the carve out operated in accordance with the state's intentions to control costs and improve access to treatment However, Frank and McGuire (1997) examined MHMA's financial performance in the first three and a half years and determined that the amount of savings produced by MHMA were far in excess of any incentives that existed in the contract The authors speculated that MHMA was motivated to achieve significant cost reductions because they were a young company with a reputation to build and that their performance was relatively insensitive to the financial incentives.