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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 11/2020

01-11-2020 | Eye Examinations | Original Research

Effects of Maryland’s Affordable Care Act Medicaid Health Home Waiver on Quality of Cardiovascular Care Among People with Serious Mental Illness

Authors: Emma E. McGinty, PhD, MS, Elizabeth M. Stone, MSPH, Alene Kennedy-Hendricks, PhD, Sachini Bandara, PhD, Karly A. Murphy, MD, MHS, Elizabeth A. Stuart, PhD, Michael A. Rosenblum, PhD, Gail L. Daumit, MD, MHS

Published in: Journal of General Internal Medicine | Issue 11/2020

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Abstract

Background

Nineteen US states and D.C. have used the Affordable Care Act Medicaid health home waiver to create behavioral health home (BHH) programs for Medicaid beneficiaries with serious mental illness (SMI). BHH programs integrate physical healthcare management and coordination into specialty mental health programs. No studies have evaluated the effects of a BHH program created through the Affordable Care Act waiver on cardiovascular care quality among people with SMI.

Objective

To study the effects of Maryland’s Medicaid health home waiver BHH program, implemented October 1, 2013, on quality of cardiovascular care among individuals with SMI.

Design

Retrospective cohort analysis using Maryland Medicaid administrative claims data from July 1, 2010, to September 30, 2016. We used marginal structural modeling with inverse probability of treatment weighting to account for censoring and potential time-dependent confounding.

Participants

Maryland Medicaid beneficiaries with diabetes or cardiovascular disease (CVD) participating in psychiatric rehabilitation programs, the setting in which BHHs were implemented. To qualify for psychiatric rehabilitation programs, individuals must have SMI. The analytic sample included BHH and non-BHH participants, N = 2605 with diabetes and N = 1899 with CVD.

Main Measures

Healthcare Effectiveness Data and Information Set (HEDIS) measures of cardiovascular care quality including annual receipt of diabetic eye and foot exams; HbA1c, diabetic nephropathy, and cholesterol testing; and statin therapy receipt and adherence among individuals with diabetes, as well as HEDIS measures of annual receipt of cholesterol testing and statin therapy and adherence among individuals with CVD.

Key Results

Relative to non-enrollment, enrollment in Maryland’s BHH program was associated with increased likelihood of eye exam receipt among individuals with SMI and co-morbid diabetes, but no changes in other care quality measures.

Conclusions

Additional financing, infrastructure, and implementation supports may be needed to realize the full potential of Maryland’s BHH to improve cardiovascular care for people with SMI.
Appendix
Available only for authorised users
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Metadata
Title
Effects of Maryland’s Affordable Care Act Medicaid Health Home Waiver on Quality of Cardiovascular Care Among People with Serious Mental Illness
Authors
Emma E. McGinty, PhD, MS
Elizabeth M. Stone, MSPH
Alene Kennedy-Hendricks, PhD
Sachini Bandara, PhD
Karly A. Murphy, MD, MHS
Elizabeth A. Stuart, PhD
Michael A. Rosenblum, PhD
Gail L. Daumit, MD, MHS
Publication date
01-11-2020
Publisher
Springer International Publishing
Published in
Journal of General Internal Medicine / Issue 11/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-020-05690-9

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