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State policies designed to decrease Medicaid enrollment may have led to increased use of state psychiatric hospitals by former Medicaid enrollees with schizophrenia.

BackgroundChildren’s health and healthcare use are impacted by both medical conditions and social factors, such as their home and community environment. As healthcare systems manage a pediatric population, information about these factors is crucial to providing quality care coordination.MethodsThe authors developed a novel methodology combining medical complexity (using the Pediatric Medical Complexity Algorithm) and social complexity (using available family social factors known to impact a child’s health and healthcare use) to create a new health complexity model at both the population-level and individual-level. System-level data from Oregon’s Medicaid Management Information Systems and Integrated Client Services database was analysed, examining claims data and service utilization, to calculate the health complexity of children enrolled in Medicaid/Child Health Insurance Program (CHIP) across Oregon.ResultsOf the 390 582 children ages 0 to 17 enrolled in Medicaid/CHIP in Oregon from July 2015 to June 2016, 83.4% (n=325 900) had some level of medical and/or social complexity and 22.1% (n=85 839) had health complexity (both medical and social complexity). Statistically significant (p<0.05) differences in health complexity were observed among attributed patients by Oregon’s 16 Coordinated Care Organizations, as well as by a child’s age, county of residence and race/ethnicity.ConclusionsGiven the high proportion of children with health complexity, these findings demonstrate that a large number of Medicaid/CHIP-insured children could benefit from targeted care coordination and differential resource allocation. Reports have been shared with state, county and health system leaders to drive work across the state. This paper describes the collaborative process necessary for other states considering similar work.

To assess the readiness of mental health facilities in Oregon to implement medication algorithms using the Medication Management Approaches in Psychiatry toolkit (MedMAP) developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), researchers conducted interviews with 68 clinical and administrative employees of four inpatient and four outpatient mental health facilities in Oregon. Opinions about the algorithms among respondents were generally positive, but were accompanied by many concerns about logistics and implementation, chiefly related to medication selection and expected restrictions on choices for prescribing providers and patients. The implementation of medication algorithms may benefit from assessing staff perspectives and capabilities of program infrastructure. The extent to which staff concerns, values, and needs are anticipated and promptly and responsively addressed is likely have a major influence on successful implementation. Keywords psychiatric medication; medication algorithms; organizational change; infrastructure assessment; Texas Medication Algorithm Project Psychiatric disorders are a great burden on patients' quality of life and an enormous contributor to the cost of state-funded health care, despite the availability of effective psychiatric interventions. State mental health authorities struggle with the high costs of antipsychotic medications 1 and are eager to find ways to reduce expenditures while maintaining or increasing Correspondence/reprints: Jennifer P. Wisdom PhD MPH.