This article describes the Seattle Homeless Adolescent Research Project (SHARP), a research demonstration program with a goal of implementing and evaluating an intensive mental health case management program for homeless adolescents. This new program, Project Passage, is based on nine primary components: (a) assessment, (b) planning, (c) linkage, (d) monitoring or tracking, (e) advocacy, (f) counseling or the therapeutic relationship, (g) treatment teams, (h) crisis service, and (i) flexible funds. Case load was limited to no more than 12 cases, so that adolescent-centered, individualized services could be delivered. Youths were randomly assigned to Project Passage or a “regular” case management program. A 3-month follow-up found that both groups demonstrated significant improvements in mental health outcomes and social adjustment; however, youths in Project Passage evidenced lower levels of aggression and greater satisfaction with their quality of life.

IntroductionIn 2010, national guidelines recommended that women with nonmetastatic, hormone receptor–positive breast cancer take adjuvant hormone therapy for 5 years. As results from randomized clinical trials became available, guidelines were revised in 2014 to recommend 10 years of therapy. Despite evidence of its efficacy, low initiation rates have been documented among women insured by New York State Medicaid. This article describes a coordinated quality improvement pilot conducted by a state department of health and Medicaid managed care plans to engage women in guideline-concordant adjuvant hormone therapy.MethodsWomen enrolled in Medicaid managed care with nonmetastatic, hormone receptor–positive breast cancer and who had surgery from May 1, 2012, through November 30, 2012, were identified using linked Medicaid and Cancer Registry data. Adjuvant hormone therapy status was determined from Medicaid pharmacy data. Contact information for nonadherent women was supplied to health plan care managers who conducted outreach activities. Adjuvant hormone therapy status in the 6 months following outreach was evaluated.ResultsIn the 6 months postoutreach, 61% of women in the contacted group filled at least 1 prescription, compared with 52% in the noncontacted group. Among those with at least 1 filled prescription, 50% of the contacted group were adherent, compared with 25% in the noncontacted group.ConclusionThis pilot suggests outreach conducted by health plan care managers, facilitated by linked Medicaid and Cancer Registry data, is an effective method to improve adjuvant hormone therapy initiation and adherence rates in Medicaid managed care–insured women.

ABSTRACT

Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012–June 2014) was compared to health care outcomes in the final year (July 2014–June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (−$262.91 [95% confidence interval (CI), −325.40 to −200.42] to −$379.82 [95% CI, −451.27 to −308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99–904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (−$235.64 [95% CI, −299.95 to −171.33]) and IP (−$181.39 [95% CI, −208.73 to −154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.

BACKGROUND: The objective of this study was to evaluate an ongoing initiative to improve colorectal cancer (CRC) screening uptake in the New York State (NYS) Medicaid managed care population. METHODS: Patients aged 50 to 75 years who were not up to date with CRC screening and resided in 2 NYS regions were randomly assigned to 1 of 3 cohorts: no mailed reminder, mailed reminder, and mailed reminder + incentive (in the form of a $25 cash card). Screening prevalence and the costs of the intervention were summarized. RESULTS: In total, 7123 individuals in the Adirondack Region and 10,943 in the Central Region (including the Syracuse metropolitan area) were included. Screening prevalence in the Adirondack Region was 7.2% in the mailed reminder + incentive cohort, 7.0% in the mailed reminder cohort, and 5.8% in the no mailed reminder cohort. In the Central Region, screening prevalence was 7.2% in the mailed reminder cohort, 6.9% in the mailed reminder + incentive cohort, and 6.5% in the no mailed reminder cohort. The cost of implementing interventions in the Central Region was approximately 53% lower than in the Adirondack Region. CONCLUSIONS: Screening uptake was low and did not differ significantly across the 2 regions or within the 3 cohorts. The incentive payment and mailed reminder did not appear to be effective in increasing CRC screening. The total cost of implementation was lower in the Central Region because of efficiencies generated from lessons learned during the first round of implementation in the Adirondack Region. More varied multicomponent interventions may be required to facilitate the completion of CRC screening among Medicaid beneficiaries.

No abstract

IntroductionPreventive dental services have been associated with improved health outcomes. This study expands on previous observations by examining the relationship between oral health care and health care outcomes and costs in a publicly insured population with diabetes.MethodsUtilization of dental services, health care outcomes and costs were evaluated for New York State Medicaid members with a diagnosis of diabetes mellitus (DM), ages 42 to 64, who were continuously enrolled between July 1, 2012 and June 30, 2015. Utilization of dental services focused on preventive dental care (PDC), and extractions and endodontic treatment (both indicative of advanced dental infection). Data were analyzed using regression models with propensity score weighting to control for potential confounding.ResultsReceipt of PDC was associated with lower utilization rates and costs compared to members who did not access dental services. The most pronounced average cost difference was observed for inpatient admissions at $823 per year for members who had at least one PDC without extraction or endodontic treatment. Each additional PDC visit received was associated with an 11% lower rate of inpatient admissions and lower average inpatient costs by $407 per member. The need for a dental extraction or endodontic therapy was associated with relatively higher rates and costs.ConclusionsThese findings demonstrate an association between PDC and improved health care outcome rates and lower average costs among members with DM and suggest a general health benefit associated with provision of preventive dental care for persons with DM.

ED reliance is associated with rural residence. Increased access to primary and specialty care in rural settings could help reduce EDR, particularly among rural adolescents.