A Comparison of Acute Psychiatric Care Under Medicaid Carve-Outs, HMOs, and Fee-for-Service

Abstract

This study compares the use of acute psychiatric hospitalization; selected outcomes, including rehospitalization; as well as costs associated with the health maintenance organization (HMO), carve-out, and fee-for-service models as implemented in the Massachusetts Medicaid program between FY1994 and FY2000. This is a longitudinal analysis that primarily uses unduplicated individual data from the Massachusetts Case Mix database. Analyses focus on 56,518 individuals who were psychiatrically hospitalized on acute units within 57 hospitals. They employ Cox regression to compare rehospitalization among the three programs. The hypotheses were strongly supported: HMOs have the most substantial impacts in minimizing service provision, with the carve-out program having an impact intermediate between the HMO and fee-for-service programs. Lower utilization rates were associated with lower overall rates of hospitalization, shorter lengths of stay, fewer repeated stays, and less geographic access and greater displacement of psychiatric patients to medical units. The final model of rehospitalization has an overall predictive accuracy of 59.6%.

The relationship between insurance and health outcomes of diabetes mellitus patients in Maryland: a retrospective archival record study

“…When different healthcare providers prescribe different care plans, negative health outcomes may result [ 18 ]. In the MC plan, a specific amount is established for each insured person when the enrollee receives care from approved providers regardless of the number of procedures undertaken [ 15 , 18 , 19 ]. To minimize the number of procedures, the healthcare provider actively manages the enrollee’s health.…”

“…To minimize the number of procedures, the healthcare provider actively manages the enrollee’s health. MC enrollees with chronic diseases are required to participate in regular preventive visits, which improves health outcomes and the single-point access prevents fragmentation of care and provides continuity of care [ 19 ].…”

The Relationship Between Insurance and Health Outcomes of Diabetes Mellitus Patients in Maryland: A Retrospective Archival Record Study

“…When enrollees receive care from approved providers, there is also a continuity of care and a single-point access of care, which prevent fragmentation of care and improve health outcomes. [15] Health maintenance organizations, which provide MC plans, generally report lower overall rates of hospitalization, shorter LOS, and fewer repeated stays. [15] Since MC enrollees with chronic diseases are required to participate in regular preventive visits and the single-point access provides continuity of care, it can be expected that DM patients will have better health outcomes compared to those who are enrolled in FFS plans.…”

“…[14] In the MC plan, a speci c amount is established for each insured person regardless of the number of procedures undertaken when the enrollee receives care from approved providers. [11,14,15] To minimize the number of procedures, the healthcare provider actively manages the enrollee's health. When enrollees receive care from approved providers, there is also a continuity of care and a single-point access of care, which prevent fragmentation of care and improve health outcomes.…”

Exploring Mental Health Treatment and Prevention among Homeless Older Adults

“…Moreover, it is well documented that a range of personal, social, economic, and environmental factors contribute to individual and population health [5,6]. Specifically, people with better education, more stable employment, stable housing and living arrangements, and access to preventive health services tend to be healthier across the life course [7,8]. Conversely, poor health care outcomes are often made worse by a lack of access and opportunities to engage in health social and physical environments [9,10].…”