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September 9, 1998

Managed Care for Mental Health in Tennessee

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(10):884-885. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-10-jac80015

To the Editor.—As a researcher involved in Medicaid managed care for more than a dozen years, I have struggled for some time with how to interpret and explain the TennCare experience. I used to comment facetiously that it should be referred to as the "Just do it!" approach to implementing a Medicaid managed care program. I have suggested that while Tennessee may have a higher percentage of persons covered by managed care than other areas of the country, it may be among the poorest forms of managed care in the country with which to do it. The article by Chang and colleagues1 on the insanity of the mental health program that has been launched and now grounded in Tennessee brings to mind what I think is a more appropriate viewpoint. In many respects, TennCare has become the Mir spacecraft of the Medicaid program. And someone ought to consider seriously whether this wayward vehicle ought not be brought back to earth.

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