Schizophrenia, Co-occurring Substance use Disorders and Quality of Care: The Differential Effect of a Managed Behavioral Health Care Carve-out

Busch, Alisa B.; Frank, Richard G.; Lehman, Anthony F.; Greenfield, Shelly F.

doi:10.1007/s10488-006-0045-3

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…Several evaluations (Busch, Frank, Lehman, & Greenfield, 2006;Busch, 2002;Manning et al, 1999;Ray, Daugherty, & Meador, 2003) examined the impacts of carve-outs on special populations and reported mixed outcomes. Some of these found that carve-out programs had negative effects on special populations, including higher rates of discontinuity of antipsychotic medication among patients with severe mental illness in Tennessee; poorer outcomes for Medicaid recipients with schizophrenia in Utah; and decreases in psychosocial treatments for patients with schizophrenia alone and schizophrenia with co-occurring substance abuse (Ray et al, 2003).…”

Section: Comparisons Of Ffs and Managed Care Plansmentioning

confidence: 99%

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

Hudson

Chafets

2010

Social Work in Public Health

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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%.

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Section: Comparisons Of Ffs and Managed Care Plansmentioning

confidence: 99%

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

Hudson

Chafets

2010

Social Work in Public Health

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“…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. Performance may also Frank · Garfield differ for individuals who experience substance abuse problems and mental health care problems (11,56), although few studies allow for comparisons of these two types of services within the same evaluation. 8 Finally, the variation in findings may be due to ownership of carve-outs, as evidenced by Colorado's experience where larger impacts were observed under the for-profit relative to communitybased Medicaid carve-outs.…”

Section: Wwwannualreviewsorg • Behavioral Health Care Carve-outsmentioning

confidence: 99%

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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“…We included adults aged 18–64 years who were not dually enrolled in Medicare or a managed care plan during the 180 days before their first SGA fill. Enrollees were classified as having schizophrenia if they had at least two claims (inpatient or outpatient, on separate service dates) for schizophrenia (ICD‐9‐CM 295.x) from July 2000 to December 2006 . Enrollees were classified as having bipolar disorder if they did not have schizophrenia and had at least two claims for a bipolar spectrum disorder (ICD‐9‐CM 296.0, 296.1, 296.4–296.8) …”

Section: Methodsmentioning

confidence: 99%

Changes in antipsychotic use among patients with severe mental illness after a Food and Drug Administration advisory

Dusetzina

Busch

Conti

et al. 2012

Pharmacoepidemiology and Drug

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Purpose A 2003 FDA advisory warned of increased hyperlipidemia and diabetes risk for patients taking second-generation antipsychotics (SGAs). Following the advisory a professional society consensus statement provided treatment recommendations and stratified SGAs into high, intermediate, and low metabolic risk. We examine subsequent changes in incident and prevalent SGA use among individuals with severe mental illness. Methods Retrospective, observational study using Florida Medicaid’s claims from 2001–2006. We include non-Medicare eligible adults with bipolar disorder or schizophrenia who filled a SGA prescription. Among prevalent users we assess changes in overall and agent-specific use; discontinuations; interruptions; and therapeutic alternative use; among incident users, agent-specific use. Pre-advisory utilization was compared with utilization initially following the advisory and two subsequent periods. Results Among prevalent users, overall SGA use declined slightly and no increases in treatment interruptions or discontinuations were observed following the advisory and consensus statement publication. Compared with the pre-advisory period, in the months immediately following use of the highest metabolic-risk agent, olanzapine, decreased by 34% among prevalent users with bipolar disorder (adjusted risk ratio [aRR]=0.66; 95% confidence intervals [CI]=0.59–0.74) and 26% among prevalent users with schizophrenia (aRR=0.74, CI=0.72–0.76). A greater decline was estimated among incident users with bipolar disorder (aRR=0.37; CI=0.29–0.47) and schizophrenia (aRR=0.42; CI=0.35–0.51) during this period. During each subsequent post-advisory period, olanzapine use continued to decline while quetiapine, ziprasidone, and aripiprazole use increased. Conclusions The metabolic risk advisory and published consensus statement were associated with a selective reduction in olanzapine use without evidence of treatment disruptions among this population.

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Schizophrenia, Co-occurring Substance use Disorders and Quality of Care: The Differential Effect of a Managed Behavioral Health Care Carve-out

Cited by 11 publications

References 27 publications

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

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

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

Changes in antipsychotic use among patients with severe mental illness after a Food and Drug Administration advisory

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