Managed behavioral healthcare in the public sector

For over 10 years states and counties have been adding commercially developed managed care products to community-based systems of care. These programs have dramatically altered the landscape in many public systems across the country. Results have varied from modest success to major failure with some managed behavioral healthcare organizations no longer viewing public contracts as desirable commodities. This article examines the reasons why public purchasers turn to managed care, the basis for a program's success or failure, and the impact of some successful programs on access and service array.