TY - JOUR
T1 - The effects of the Maryland Medicaid Health Home Waiver on Emergency Department and inpatient utilization among individuals with serious mental illness
AU - Bandara, Sachini N.
AU - Kennedy-Hendricks, Alene
AU - Stuart, Elizabeth A.
AU - Barry, Colleen L.
AU - Abrams, Michael T.
AU - Daumit, Gail L.
AU - McGinty, Emma E.
N1 - Funding Information:
Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award numbers: K01MH106631 (PI: McGinty), R24MH102822 (PI: Daumit), and T32MH109436 (PI: Barry/Stuart).
Funding Information:
Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award numbers: K01MH106631 (PI: McGinty), R24MH102822(PI: Daumit), and T32MH109436 (PI: Barry/Stuart).Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award numbers: K01MH106631 (PI: McGinty), R24MH102822(PI: Daumit), P50MH115842 (Daumit) and T32MH109436 (PI: Barry/Stuart). Thanks to the Hilltop Institute at University of Maryland Baltimore County for their role in compiling the administrative claims data used in this study. The authors gratefully acknowledge Tricia Roddy and Alyssa Brown at the Maryland Department of Health for their support and input throughout the project. None.
Funding Information:
Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award numbers: K01MH106631 (PI: McGinty), R24MH102822 (PI: Daumit), P50MH115842 (Daumit) and T32MH109436 (PI: Barry/Stuart). Thanks to the Hilltop Institute at University of Maryland Baltimore County for their role in compiling the administrative claims data used in this study. The authors gratefully acknowledge Tricia Roddy and Alyssa Brown at the Maryland Department of Health for their support and input throughout the project.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Objective: The Maryland Medicaid health home program, established through the Affordable Care Act's Medicaid health home waiver, integrates primary care services into specialty mental health programs for adults with serious mental illness (SMI). We evaluated the effect of this program on all-cause, physical, and behavioral health emergency department (ED) and inpatient utilization. Method: Using marginal structural modeling to control for time-invariant and time-varying confounding, we analyzed Medicaid administrative claims data for 12,232 enrollees with SMI from October 1, 2012 to December 31, 2016; 3319 individuals were enrolled in a BHH and 8913 were never enrolled. Results: Health home enrollment was associated with reduced probability of all-cause (PP: 0.23 BHH enrollment vs. 0.26 non-enrollment, p < 0.01) and physical health ED visits (PP: 0.21 BHH enrollment vs. 0.24 non-enrollment, p < 0.01) and no effect on inpatient admissions per person-three-month period. Conclusion: These results suggest the Maryland Medicaid health home waiver's focus on supporting physical health care coordination by specialty mental health programs may be preventing ED visits among adults with SMI, although effect sizes are small.
AB - Objective: The Maryland Medicaid health home program, established through the Affordable Care Act's Medicaid health home waiver, integrates primary care services into specialty mental health programs for adults with serious mental illness (SMI). We evaluated the effect of this program on all-cause, physical, and behavioral health emergency department (ED) and inpatient utilization. Method: Using marginal structural modeling to control for time-invariant and time-varying confounding, we analyzed Medicaid administrative claims data for 12,232 enrollees with SMI from October 1, 2012 to December 31, 2016; 3319 individuals were enrolled in a BHH and 8913 were never enrolled. Results: Health home enrollment was associated with reduced probability of all-cause (PP: 0.23 BHH enrollment vs. 0.26 non-enrollment, p < 0.01) and physical health ED visits (PP: 0.21 BHH enrollment vs. 0.24 non-enrollment, p < 0.01) and no effect on inpatient admissions per person-three-month period. Conclusion: These results suggest the Maryland Medicaid health home waiver's focus on supporting physical health care coordination by specialty mental health programs may be preventing ED visits among adults with SMI, although effect sizes are small.
KW - Behavioral health home
KW - Care coordination
KW - Medicaid
KW - Serious mental illness
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U2 - 10.1016/j.genhosppsych.2019.12.004
DO - 10.1016/j.genhosppsych.2019.12.004
M3 - Article
C2 - 31948691
AN - SCOPUS:85077735301
VL - 64
SP - 99
EP - 104
JO - General Hospital Psychiatry
JF - General Hospital Psychiatry
SN - 0163-8343
ER -