This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and $228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization.

Objective To investigate the employment outcomes of vocational rehabilitation (VR) services for youth with disabilities in a targeted, enhanced, and contract-based secondary transition program as compared to the traditional VR transition services. Methods A population-based study was conducted on 4422 youth with physical, intellectual, learning, mental and hearing disabilities aged 14-21 at application and whose case was closed after receiving VR transition services in a Midwestern state. Selected youth were classified into either targeted secondary transition program (START) or non-START treatment group. The employment outcomes of the groups were compared using propensity-score matching procedures. Results 2211 youth with disabilities in each treatment group were successfully matched based on demographic characteristics, types of disabilities, existence of severe functional limitations, and year of referral. The overall rehabilitation rate was 57 % [95 % confidence interval (CI) 56-59 %], where the START group rate was 61 % (95 % CI 59-63 %) and the non-START group 53 % (95 % CI 51-55 %). The propensity-score matched odds ratio (OR) was 1.40 (95 % CI 1.24-1.58; p < 0.001). Subgroup analyses showed that the odds of rehabilitation in youth with disabilities were consistently higher when they were in START as compared to non-START (OR ranged from 1.27 to 1.92 with p < 0.05 except for the Hispanic subgroup). Conclusion The results suggest that VR services in a targeted, enhanced, and contract-based secondary transition program are more effective in transitioning youth with disabilities to employment than the regular VR transition services.

The objective of this study was to assess whether successful vocational rehabilitation (that is, obtaining employment) among people with disabilities was affected by residential arrangement. Five groups of residential placement were considered: individuals living in a private residence, community or group residential, correctional and rehabilitation facilities, nursing home/mental health facilities, and homeless/shelter/other type of residential arrangement. The study involved a total of 46,570 vocational rehabilitation consumers aged 18 to 65 at referral in a Midwestern state. Statistical modeling was performed using quasibinomial logistic regression. It was found that compared to individuals living in private residences, those in correctional or rehabilitation facilities were at increased odds of successful rehabilitation, whereas those living in homeless/shelter/other residential arrangement and those living in nursing homes/mental health facilities were in significantly decreased odds of being rehabilitated. Individuals living in community or group residential, however, had no statistical difference in vocational rehabilitation outcomes compared to individuals living in private residences. The implications for rehabilitation research and practice are discussed.

Compared to individuals without disabilities, those with disabilities experience inequalities in finding and sustaining employment that are more profound among women and minorities. The purpose of this study is to examine differences in employment outcomes for African American and white women with disabilities who received vocational rehabilitation (VR) services. The VR data that this study used included 18,602 women, 18-65 years old at entry into the VR system in a Midwestern state. Using logistic regression analyses, we found that, compared to white women, African American women had lower odds of employment. Middleaged women were more likely to find jobs than were younger women, and women of both racial groups who received SSI/SSDI were less likely to be employed. Finally, VR services were significantly associated with employment for both races. We discuss the need to examine VR policies and practices to improve employment outcomes of African American women with disabilities.

Background Viral infection can compound the severity of pre-existing inflammation caused by underlying diseases. For those with a chronic, immune-related condition such as diabetic foot ulcers (DFUs), the coronavirus disease (COVID-19) serves to exacerbate the inflammatory burden. Serum levels of intracellular adhesion molecule-1 (ICAM-1), a primary mediator of cell adhesion express in the inflammatory process, are often used to indicate the gravity of all inflammatory conditions. Therefore, the purpose of this study was to investigate serum ICAM-1 levels before and after debridement in patients with DFUs who were also diagnosed as COVID-19 positive compared with those who were COVID-19 negative. Methods 20 patients with DFUs were screened for COVID-19 and then divided into COVID-19 positive and negative groups according to the results. Before debridement, chest x-rays and blood analysis, including ICAM-1 serum levels, were performed in both groups. Only ICAM-1 serum levels were measured after debridement. Results Of the 20 patients included in this study, 55% were male (n = 11) and 45% were female (n = 9). The mean age was 52.9 ± 1.9 years. ICAM-1 levels in patients with DFU in the COVID-19-positive group were significantly higher than those in the COVID-19-negative group (median 317.2 vs 149.2, respectively; p < 0.001). Serum levels of ICAM-1 reduced significantly in patients with DFU in the COVID-19-positive group were significantly higher than those in the COVID-19-negative group after debridement (median 312.5 vs 130.3; p < 0.001). Conclusion ICAM-1 serum levels represent an additional, initial screening marker for COVID-19.