Medicaid Managed Care and the Distribution of Societal Costs for Persons With Severe Mental Illness

Shern, David L.; Jones, Kristine; Chen, Huey Jen; Jordan, Neil; Perazzi, Josefa Ramoni; Boothroyd, Roger A.

doi:10.1176/appi.ajp.2007.06122089

Cited by 12 publications

(8 citation statements)

References 30 publications

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“…Otherwise, the program was fee-for-service (although, outpatient Medicaid fees are typically low relative to the market price thereby limiting the supply of services). In 1996 the state implemented in one county (Tampa) a behavioral health carve-out, the impact of which has previously been studied 8-10. The carve-out was capitated and financially at risk for inpatient and outpatient utilization, but not medications.…”

Section: Methodsmentioning

confidence: 99%

Changes Over Time and Disparities in Schizophrenia Treatment Quality

Busch¹,

Lehman²,

Goldman³

et al. 2009

Medical Care

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Background Schizophrenia medication and psychosocial treatment options have expanded since the Schizophrenia PORT was conducted. However, there also have been considerable changes in the delivery of mental health care in the public sector, as well as increasing state concerns about Medicaid cost containment. Objectives To examine trends and patient characteristics associated with differences in schizophrenia medication and visit treatment quality in a Medicaid population. Research Design Observational study of claims data from July 1, 1996 to June 30, 2001. Subjects Florida Medicaid enrollees diagnosed with schizophrenia (N=23,619). Measures We examined the likelihood of meeting any one and all four of the following quality standards: 1) receiving antipsychotic medication, 2) antipsychotic continuity and 3) dosing consistent with PORT recommendations and, 4) mental health visit continuity. Separate models were fit for acute and maintenance phases of treatment. Results Approximately 18% of acute and 7% of maintenance phases met all four quality standards. Antipsychotic quality improved (largely driven by an increasingly likelihood of receiving any antipsychotic), while visit continuity declined. The greatest disparities were seen for persons with co-occurring substance use disorders and of Black race. Quality differences were often phase specific and at times in opposite directions across treatment phases. Conclusions The improvement in antipsychotic treatment quality is encouraging. However, visit continuity declined. This study highlights the importance of quality measurement that includes focus on different treatment modalities and phases of care, as well as for potentially vulnerable populations (such as persons with co-occurring substance use disorders and minority race/ethnicity).

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Section: Methodsmentioning

confidence: 99%

Changes Over Time and Disparities in Schizophrenia Treatment Quality

Busch¹,

Lehman²,

Goldman³

et al. 2009

Medical Care

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“…Because of budget constraints, many states have been transitioning enrollees with disabilities to MMC with a hope of both reducing or stabilizing the state's costs and ensuring better access to health services for enrollees (Sparer, 2012). Yet, previous researchers have reported mixed findings on the impact of MMC (Burns, 2009b;Caswell & Long, 2015;Coughlin et al, 2008;Shern et al, 2007;Yamaki et al, 2019). For persons with early-acquired physical disabilities, Medicaid is a primary source of health services required to meet their complex health care needs, some of which may intensify as they age.…”

Section: Discussionmentioning

confidence: 99%

Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care

et al. 2018

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Objective: We evaluated the impact of Medicaid managed care (MMC) on health service use and state costs among adults with early-acquired physical disabilities. Method: Using claims data, we tracked utilization of the emergency department (ED), inpatient admissions, outpatient physician visits, and state expenditures on enrollees who transitioned to MMC ( n = 881). The inverse propensity score weight and a difference-in-differences regression model were used to estimate the impact of MMC using their counterparts who remained in fee-for-service ( n = 1,552) as the comparison group. Results: MMC reduced ED use by 3.2% points/month ( p < .001). Relative to younger enrollees (age ⩽45 years), MMC reduced inpatient admissions of older enrollees (age ⩾46 years) by 3.3% points/month ( p < .001), and state expenditures by US$839/month ( p < .01). Discussion: MMC could reduce the hospital service use of and state spending on enrollees with early-acquired physical disabilities. This impact may vary depending on the enrollees’ age.

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“…They also found little difference in the costs of physical health services by financial risk arrangement. In a followup study, however, Shern et al 253 found that although the Medicaid managed care plan resulted in cost savings, the savings were either diminished or eliminated when including all societal costs, including private and family expenditures. In particular, people in Medicaid managed care plans appeared to receive significantly more informal caregiving than people in fee-for-service plans.…”

Section: Carve-outs Capitation and Managed Behavioral Healthmentioning

confidence: 99%

“…It is, thus, essential to understand the distributional and societal cost impact of different risk-based financing strategies. 253 Several studies have also highlighted differences in utilization among subpopulations being served in MBHCOs. For example, comparing two captitation models and a fee-for-service model in Colorado's Medicaid program, Kaskie et al 248 found that utilization among older beneficiaries decreased more in the "joint-venture" capitated model, in which a for-profit organization collaborated with a community mental health agency, than in the nonprofit public capitated model.…”

Section: Carve-outs Capitation and Managed Behavioral Healthmentioning

confidence: 99%