Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

Abstract

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.

Impact of the 1115 behavioral health Medicaid waiver on adult Medicaid beneficiaries in New York State

“…Although the study used a matched control DID approach, it did not differentiate between the types of visits, had a shorter follow-up period of 12 months, and did not employ a more robust PS analysis in mitigating the baseline differences between groups. This study used a PS adjusted DID approach, and the findings are consistent with studies that used 12,29 similar approaches in evaluating the impacts of the integrated (carve-in) plan in the states of Illinois and Washington. There was also evidence of increases in the use of OMH specialty services (ACT and PROS), although PROS was only statistically significant in the NYC phase.…”

“…Similar findings have been reported in studies that examine the effects of behavioral carve-in for individuals with serious mental conditions. 12,29 Likewise, the study showed reductions in the average length of behavioral and nonbehavioral inpatient stays an overall decrease in ambulatory visits for individuals switching from Medicaid fee-for-service to MMC. Although the study used a matched control DID approach, it did not differentiate between the types of visits, had a shorter follow-up period of 12 months, and did not employ a more robust PS analysis in mitigating the baseline differences between groups.…”

“…Although several studies have examined the impact of integrated MMC "carve-in" for Medicaid beneficiaries with behavioral health conditions, the findings have been mixed with some evidence of effectiveness. 12,26,27 Nevertheless, much of the findings seem to suggest that MMC leads to reductions in medical cost, ER visits, fewer inpatient stays, and increased outpatient use. 12,28,29 While the findings of this study suggest that HARPs were associated with a relative increase in outpatient services, a relative reduction in inpatient stays and length of stays, and a relative decline in ER services, it is of note that service use in both groups generally declined in the pre-to post-HARP period comparisons.…”

“…12,26,27 Nevertheless, much of the findings seem to suggest that MMC leads to reductions in medical cost, ER visits, fewer inpatient stays, and increased outpatient use. 12,28,29 While the findings of this study suggest that HARPs were associated with a relative increase in outpatient services, a relative reduction in inpatient stays and length of stays, and a relative decline in ER services, it is of note that service use in both groups generally declined in the pre-to post-HARP period comparisons. This may in part be due to the various health care reforms (ACA, DSRIP, CCMP, and MMC) in the health care delivery system which likely led to new and improved services.…”

“…In fact, the authors argued "absent the SMART Act, it is likely that ICP would have significantly reduced Medicaid spending per person per month". 12 To address the unique needs of adults with serious behavioral health conditions, NYS developed a specialty MMC product called a Health and Recovery Plan (HARP). HARPs offer access to an enhanced benefit package comprised of Home and Community-Based…”