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Community Mental Health Journal
Published in: Community Mental Health Journal 5/2015

01-07-2015 | Original Paper

Planning Patient-Centered Health Homes for Medicaid Psychiatric Patients at Greatest Risk for Intensive Service Use

Authors: Joyce C. West, Donald S. Rae, Ramin Mojtabai, Farifteh F. Duffy, Janet Kuramoto, Eve Moscicki, William E. Narrow

Published in: Community Mental Health Journal | Issue 5/2015

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Abstract

This study identified characteristics of Medicaid psychiatric patients at risk of hospitalizations and emergency department (ED) visits to identify their service delivery needs. A total of 4,866 psychiatrists were randomly selected from the AMA Physician Masterfile; 62 % responded, 32 % met eligibility criteria and reported on 1,625 Medicaid patients. Patients with schizophrenia, substance use disorders, suicidal and violent ideation/behavior, and psychotic, substance use, or manic symptoms were at high risk for intensive service use, along with homeless and incarcerated patients. Patients with schizophrenia or psychotic symptoms represented 37 % of patients, but used 73 % of all hospital days and 61 % of all ED visits. Patients with substance use problems comprised 21 % of patients, but used nearly half of all ED visits. Our findings highlight opportunities to enhance treatments and interventions, and inform the development of patient-centered health homes to address the needs of patients at high risk for intensive service use.
Literature
Bach, P., & Hayes, S. C. (2002). The use and acceptance of commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70(5), 1129–1139.PubMedCrossRef
Bharel, M., Lin, W. C., Zhang, J., O’Connell, E., Taube, R., & Clark, R. E. (2013). Health care utilization patterns of homeless individuals in Boston: Preparing for Medicaid expansion under the Affordable Care Act. American Journal of Public Health, 103(Suppl 2), S311–S317.PubMedCentralPubMedCrossRef
Brown, R. S., Peikes, D., Peterson, G., Schore, J., & Razafindrakoto, C. M. (2012). Six features of medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Affairs, 31(6), 1156–1166.PubMedCrossRef
Capp, R., Rosenthal, M. S., Desai, M. M., Kelley, L., Borgstrom, C., Cobbs-Lomax, D. L., et al. (2013). Characteristics of Medicaid enrollees with frequent ED use. American Journal of Emergency medicine, 31(9), 1333–1337.PubMedCrossRef
Cook, P. F., Emiliozzi, S., Waters, C., & El Hajj, D. (2008). Effects of telephone counseling on antipsychotic adherence and emergency department utilization. American Journal of Managed Care, 14(12), 841–846.PubMed
Essock, S., Frisman, L., & Kontos, N. (1998). Cost-effectiveness of assertive community treatment teams. American Journal of Orthopsychiatry, 68, 179–190.PubMedCrossRef
Gilmer, T. P., Dolder, C. R., Lacro, J. P., Folsom, D. P., Lindamer, L., Garcia, P., & Jeste, D. V. (2004). Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. American Journal of Psychiatry, 161(4), 692–699.PubMedCrossRef
Grimes, K. E., Schulz, M. F., Cohen, S. A., Mullin, B. O., Lehar, S. E., & Tien, S. (2011). Pursuing cost-effectiveness in mental health service delivery for youth with complex needs. The journal of mental health policy and economics, 14(2), 73–83.PubMed
Harman, J. S., Manning, W. G., Lurie, N., & Christianson, J. B. (2003). Association between interruptions in Medicaid coverage and use of inpatient psychiatric services. Psychiatric Services, 54(7), 999–1005.PubMedCrossRef
Haskins, J. T., MacFadden, W., Turner, N., Crivera, C., Dirani, R., Alphs, L., et al. (2010). Clinical characteristics and resource utilization of patients with bipolar disorder who have frequent psychiatric interventions. Journal of Medical Economics, 13(3), 552–558.PubMedCrossRef
Hawthorne, W. B., Folsom, D. P., Sommerfeld, D. H., Lanouette, N. M., Lewis, M., Aarons, G. A., et al. (2012). Incarceration among adults who are in the public mental health system: Rates, risk factors, and short-term outcomes. Psychiatric Services, 63(1), 26–32.PubMedCrossRef
Hazlett, S. B., McCarthy, M. L., Londner, M. S., & Onyike, C. U. (2004). Epidemiology of adult psychiatric visits to US emergency departments. Academic Emergency Medicine, 11(2), 193–195.PubMedCrossRef
Hendryx, M. S., & DeRyan, J. (1998). Psychiatric hospitalization characteristics associated with insurance type. Administration and Policy in Mental Health and Mental Health Services Research, 25(4), 437–448.PubMedCrossRef
Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. Hoboken: Wiley.
Ilgen, M. A., Hu, K. U., Moos, R. H., & McKellar, J. (2008). Continuing care after inpatient psychiatric treatment for patients with psychiatric and substance use disorders. Psychiatric Services, 59(9), 982–988.PubMedCrossRef
Kolbasovsky, A., & Futterman, R. (2007). Predicting psychiatric emergency room recidivism. Managed Care Interface, 20(4), 33–38.PubMed
LaCalle, E. J., Rabin, E. J., & Genes, N. G. (2013). High-frequency users of emergency department care. Journal of Emergency Medicine, 44(6), 1167–1173.PubMedCrossRef
Latimer, E. (1999). Economic impacts of assertive community treatment: A review of the literature. Canadian Journal of Psychiatry, 44, 443–454.
Lehman, A., Dixon, L., Hoch, J. S., Deforge, B., Kernan, E., & Frank, R. (1999). Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness. British Journal of Psychiatry, 174, 346–352.PubMedCrossRef
Mark, T., Tomic, K. S., Kowlessar, N., Chu, B. C., Vandivort-Warren, R., & Smith, S. (2013). Hospital readmission among medicaid patients with an index hospitalization for mental and/or substance use disorder. The Journal of Behavioral Health Services and Research, 40(2), 207–221.PubMedCrossRef
Mueser, K. T., Meyer, P. S., Penn, D. L., Clancy, R., Clancy, D. M., & Salyers, M. P. (2006). The illness management and recovery program: Rationale, development, and preliminary findings. Schizophrenia Bulletin, 32(Suppl 1), S32–S43.PubMedCentralPubMedCrossRef
Padgett, D. K., & Brodksy, B. (1992). Psychosocial factors influencing non-urgent use of the emergency room: A review of the literature and recommendations for research and improved service delivery. Social Science and Medicine, 35(9), 1189–1197.PubMedCrossRef
Parker, D. (2010). Housing as an intervention on hospital use: Access among chronically homeless persons with disabilities. Journal of Urban Health, 87(6), 912–919.PubMedCentralPubMedCrossRef
Peikes, D., Peterson, G., Brown, R. S., Graff, S., & Lynch, J. P. (2012). How changes in Washington University’s Medicare coordinated care demonstration pilot ultimately achieved savings. Health Affairs, 31(6), 1216–1226.PubMedCrossRef
Phillips, S. D., Burns, B. J., Edgar, E. R., Mueser, K. T., Linkins, K. W., Rosenheck, R. A., et al. (2001). Moving assertive community treatment into standard practice. Psychiatric Services, 52(6), 771–779.PubMedCrossRef
Raven, M. C., Doran, K. M., Kostrowski, S., Gillespie, C. C., & Elbel, B. D. (2011). An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: A pilot study. BMC Health Services Research, 13(11), 270.CrossRef
Research Triangle Institute. (2001). SUDAAN User’s Manual, Release 8.0. Research Triangle Park, NC: Research Triangle Institute.
Rosenheck, R. A., & Neale, M. (1998). Intersite variation in the impact of intensive psychiatric community care on hospital use. American Journal of Orthopsychiatry, 68, 191–200.PubMedCrossRef
Rosenheck, R., Neale, M., Leaf, P., Milstein, R., & Frisman, L. (1995). Multisite experimental cost study of intensive psychiatric community care. Schizophrenia Bulletin, 21, 129–140.PubMedCrossRef
Salyers, M. P., Rollins, A. L., Clendenning, D., McGuire, A. B., & Kim, E. (2011). Impact of illness management and recovery programs on hospital and emergency room use by Medicaid enrollees. Psychiatric Services, 62(5), 509–515.PubMedCentralPubMedCrossRef
Shah, B. V., Barnwell, B. G., & Bieler, G. S. (1997). SUDAAN User’s Manual, (Release 7.5 ed.). NC: Research Triangle Park, Research Triangle Institute.
Sommers, B. D., Swartz, K., & Epstein, A. (2011). Policy makers should prepare for major uncertainties in Medicaid enrollment, costs and needs for physicians under health reform. Health Affairs, 30(11), 2186–2193.PubMed
Van Dorn, R. A., Desmarais, S. L., Petrila, J., Haynes, D., & Singh, J. P. (2013). Effects of outpatient treatment on risk of arrest of adults with serious mental illness and associated costs. Psychiatric Services, 64(9), 856–862.PubMedCrossRef
Wanchek, T. N., McGarvey, E. L., Leon-Verdin, M., & Bonnie, R. J. (2011). The effect of community mental health services on hospitalization rates in Virginia. Psychiatric Services, 62(2), 194–199.PubMedCrossRef
Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629–640. doi:10.​1001/​archpsyc.​62.​6.​629.PubMedCrossRef
Weiden, P. J., Kozma, C., Grogg, A., & Locklear, J. (2004). Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatric Services, 55(8), 886–891.PubMedCrossRef
West, J. C., Wilk, J. E., Rae, D. S., Muszynski, I. S., Stipec, M. R., Alter, C. L., et al. (2009). Medicaid prescription drug policies and psychopharmacologic treatment access and continuity: Findings from ten states. Psychiatric Services, 60(5), 601–610.PubMedCrossRef
Wilk, J. E., West, J. C., Narrow, W. E., Regier, D. A., Marcus, S. C., Rubio-Stipec, M., & Rae, D. S. (2006). Comorbidity patterns in routine psychiatric practice: Is there evidence of under-detection and under-diagnosis? Comprehensive Psychiatry, 47(4), 258–264.PubMedCrossRef
Wolff, N., Helminiak, T. W., & Diamond, R. J. (1995). Estimated societal costs of assertive community mental health care. Psychiatric Services, 46(9), 898–906.PubMedCrossRef
Metadata
Title
Planning Patient-Centered Health Homes for Medicaid Psychiatric Patients at Greatest Risk for Intensive Service Use
Authors
Joyce C. West
Donald S. Rae
Ramin Mojtabai
Farifteh F. Duffy
Janet Kuramoto
Eve Moscicki
William E. Narrow
Publication date
01-07-2015
Publisher
Springer US
Published in
Community Mental Health Journal / Issue 5/2015
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI
https://doi.org/10.1007/s10597-015-9834-z

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