Effect of a Mental Health “Carve-Out” Program on the Continuity of Antipsychotic Therapy

Ray, Wayne A.; Daugherty, James R.; Meador, Keith G.

doi:10.1056/nejmsa020584

Cited by 88 publications

(32 citation statements)

References 29 publications

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“…For example, Huskamp (37) finds unequal effects of the carve-out for enrollees with unipolar depression or substance dependence. Similarly, analysis of outcomes and quality by Manning and colleagues (46) and Ray et al (52) both show the largest deterioration for groups with the poorest health or highest risk. Others express concern about the differential impact of carve-outs on children or low-income families (38); findings of higher readmission rates for children than for other Medicaid popualtions in Callahan et al (13) and greater declines in utilization for Aid to Families with Dependent Childrenrelated groups than for other beneficiaries in Christianson et al (14) indicate that experiences in Medicaid carve-outs for children and families may differ from those of disabled adult beneficiaries.…”

Section: Wwwannualreviewsorg • Behavioral Health Care Carve-outsmentioning

confidence: 81%

Managed Behavioral Health Care Carve-Outs: Past Performance and Future Prospects

Frank

Garfield

2007

Annu. Rev. Public Health

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As the managed behavioral health care market has matured, behavioral health carve-outs have solved many problems facing the delivery of behavioral health services; at the same time, they have exacerbated existing difficulties or created new problems. Carve-outs developed to address rising inpatient behavioral health costs and limited insurance coverage. They are based on the economic principles of economies of specialization, economies of scale, price negotiation, and selection. Literature shows that carve-outs have been successful in lowering costs and maintaining or improving access, but results on their impact on quality of care are mixed.

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Section: Wwwannualreviewsorg • Behavioral Health Care Carve-outsmentioning

confidence: 81%

Managed Behavioral Health Care Carve-Outs: Past Performance and Future Prospects

Frank

Garfield

2007

Annu. Rev. Public Health

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“…Carve-outs do not appear to increase rates of re-hospitalization (Sturm, 1999;Merrick, 1998). However, studies have produced mixed results on their effects on continuity of care (Ray, 2003;Merrick, 1998), adherence to treatment guidelines (Busch, Frank, & Lehman, 2004;Busch, 2002), and clinical outcomes Manning & Liu, 1999).…”

Section: Introductionmentioning

confidence: 99%

Mental health and substance abuse insurance parity for federal employees: How did health plans respond?

Barry

Ridgely

2007

J Policy Anal Manage

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“…The superior survival rates observed in trials might also reflect generally more effective anti-cancer treatment offered in the trial setting (Braunholtz et al, 2001). Other factors, such as screening for early onset of recurrence, disease progression and treatmentrelated (late) toxicities may be differently defined in the standardized research protocol of clinical trials and day-to-day clinical practice, thus potentially affecting real-world effectiveness (Ray, 2003;Ray et al, 2003;Avorn, 2007;van Herk-Sukel et al, 2010;Maraldo et al, 2015).…”

mentioning

confidence: 99%

Survival differences between patients with Hodgkin lymphoma treated inside and outside clinical trials. A study based on the EORTC‐Netherlands Cancer Registry linked data with 20 years of follow‐up

et al. 2016

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SummaryThe survival of patients diagnosed with Hodgkin lymphoma (HL) has improved from 70% to 90% in clinical trials. However, population-based data has shown lower survival. In this study, clinical trial data were linked with cancer registry to identify trial and non-trial participants and differences in overall survival and associated factors were assessed. In 1986-2004, 27% of HL patients aged 15-70 years participated in clinical trials. Compared to non-trial participants, trial participants were younger (median age, 31 vs. 34 years), had staging registered more accurately and had an 8% higher 20-year survival rate (73% vs. 65%). After adjusting for baseline differences, no differences in survival (hazard ratio = 0Á96, 95% confidence interval 0Á82-1Á12), or in subgroup analysis according to stage, remained. Over time, increased administration of chemotherapy in combination with radiotherapy, together with the decreased use of radiotherapy alone was observed among the trial population. This trend was later followed in nontrial participants, coinciding with a similar 'take-up' in survival. The observed superior survival among patients with HL treated in clinical trials can be largely explained by the differences in baseline characteristics, particularly younger age. High trial participation rate and centralized expertise facilitates the implementation of trial findings to real-world practice.Keywords: overall survival, hodgkin lymphoma, clinical trials, populationbased cancer registry, deterministic data linkage. Between 1964 and, the Lymphoma Group of the European Organisation for Research and Treatment of Cancer (EORTC) has conducted a series of phase III randomized clinical trials (RCTs) aiming to improve the efficacy of treatment in Hodgkin Lymphoma (HL), while minimizing longterm treatment-related toxicities. These subsequent trials have successfully improved the 10-year relative survival (RS) of HL patients, diagnosed between 1964 and 2004, with early stage disease from 72% to 93% and with advanced staged disease from 63% to 78% (Favier et al, 2009). However, compared to the high survival rate observed in the most recent clinical trials, that of the general patient population seems to be lower. In the Netherlands, for instance, for patients diagnosed with HL between 1989 and 2000, the 5-year RS was 78% in the general patient population (including trial participants), which is much lower than the 5-year RS seen in patients entered in clinical trials (87%). With longer follow-up, the survival gap between these two patient research paper ª

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Effect of a Mental Health “Carve-Out” Program on the Continuity of Antipsychotic Therapy

Abstract: These findings underscore the need to ensure that shifts to widely used carve-out programs, which are designed primarily to contain costs, do not adversely affect clinical outcomes.

Cited by 88 publications

References 29 publications

Managed Behavioral Health Care Carve-Outs: Past Performance and Future Prospects

Managed Behavioral Health Care Carve-Outs: Past Performance and Future Prospects

Mental health and substance abuse insurance parity for federal employees: How did health plans respond?

Survival differences between patients with Hodgkin lymphoma treated inside and outside clinical trials. A study based on the EORTC‐Netherlands Cancer Registry linked data with 20 years of follow‐up

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