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

AbstractThis 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.

[1]  Eduardo LaCalle,et al.  High-frequency users of emergency department care. , 2013, The Journal of emergency medicine.

[2]  W. Manning,et al.  Association between interruptions in medicaid coverage and use of inpatient psychiatric services. , 2003, Psychiatric services.

[3]  M. Hendryx,et al.  Psychiatric Hospitalization Characteristics Associated with Insurance Type , 1998, Administration and Policy in Mental Health and Mental Health Services Research.

[4]  M. Desai,et al.  Characteristics of Medicaid enrollees with frequent ED use. , 2013, The American journal of emergency medicine.

[5]  S. Hayes,et al.  The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. , 2002, Journal of consulting and clinical psychology.

[6]  Michael Witt,et al.  SUDAAN User's Manual, Release 9.0 , 2002 .

[7]  R. Bonnie,et al.  The Effect of Community Mental Health Services on Hospitalization Rates in Virginia , 2011, Psychiatric services.

[8]  K. Grimes,et al.  Pursuing cost-effectiveness in mental health service delivery for youth with complex needs. , 2011, The journal of mental health policy and economics.

[9]  A F Lehman,et al.  Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness , 1999, British Journal of Psychiatry.

[10]  R. Diamond,et al.  Estimated societal costs of assertive community mental health care. , 1995, Psychiatric services.

[11]  David W. Hosmer,et al.  Applied Logistic Regression , 1991 .

[12]  R. Drake,et al.  Moving assertive community treatment into standard practice. , 2001, Psychiatric services.

[13]  A. Epstein,et al.  Policy makers should prepare for major uncertainties in Medicaid enrollment, costs, and needs for physicians under health reform. , 2011, Health affairs.

[14]  Christian R. Dolder,et al.  Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. , 2004, The American journal of psychiatry.

[15]  C. Gillespie,et al.  An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study , 2011, BMC health services research.

[16]  S. Crystal,et al.  Medicaid prescription drug policies and medication access and continuity: findings from ten states. , 2009, Psychiatric services.

[17]  D. Penn,et al.  The Illness Management and Recovery program: rationale, development, and preliminary findings. , 2006, Schizophrenia bulletin.

[18]  M. Mccarthy,et al.  Epidemiology of adult psychiatric visits to US emergency departments. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[19]  B Barnwell,et al.  SUDAAN User's Manual, Release 7.5, , 1997 .

[20]  S. Crystal,et al.  Medicaid prescription drug policies and medication access and continuity: findings from ten states. , 2009, Psychiatric services.

[21]  David Parker.  Housing as an Intervention on Hospital Use: Access among Chronically Homeless Persons with Disabilities , 2010, Journal of Urban Health.

[22]  Sarah L. Desmarais,et al.  Effects of outpatient treatment on risk of arrest of adults with serious mental illness and associated costs. , 2013, Psychiatric services.

[23]  R. Clark,et al.  Health care utilization patterns of homeless individuals in Boston: preparing for Medicaid expansion under the Affordable Care Act. , 2013, American journal of public health.

[24]  D. Padgett,et al.  Psychosocial factors influencing non-urgent use of the emergency room: a review of the literature and recommendations for research and improved service delivery. , 1992, Social science & medicine.

[25]  Jennifer Schore,et al.  Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. , 2012, Health affairs.

[26]  H. Pincus,et al.  Comorbidity patterns in routine psychiatric practice: is there evidence of underdetection and underdiagnosis? , 2006, Comprehensive psychiatry.

[27]  K. Gersing,et al.  Clinical characteristics and resource utilization of patients with bipolar disorder who have frequent psychiatric interventions , 2010, Journal of medical economics.

[28]  P. Weiden,et al.  Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. , 2004, Psychiatric services.

[29]  T. Mark,et al.  Hospital Readmission Among Medicaid Patients with an Index Hospitalization for Mental and/or Substance Use Disorder , 2013, The Journal of Behavioral Health Services & Research.

[30]  Adrian T. Fisher,et al.  Social firms as a means of vocational recovery for people with mental illness: a UK survey , 2013, BMC Health Services Research.

[31]  J. Lynch,et al.  How changes in Washington University's Medicare coordinated care demonstration pilot ultimately achieved savings. , 2012, Health affairs.

[32]  S. Essock,et al.  Cost-effectiveness of assertive community treatment teams. , 1998, American Journal of Orthopsychiatry.

[33]  E. Latimer.  Economic Impacts of Assertive Community Treatment: A Review of the Literature , 1999, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[34]  The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. , 2002 .

[35]  Impact of illness management and recovery programs on hospital and emergency room use by Medicaid enrollees. , 2011 .

[36]  R. Moos,et al.  Continuing care after inpatient psychiatric treatment for patients with psychiatric and substance use disorders. , 2008, Psychiatric services.

[37]  R. Kessler,et al.  Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[38]  R. Rosenheck,et al.  Multisite experimental cost study of intensive psychiatric community care. , 1995, Schizophrenia bulletin.