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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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.
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.
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.
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.
Center for Medicare & Medicaid Services (CMS). (2010, November 26). Health Homes for Enrollees with Chronic Conditions, SMDDL#10-024. Baltimore, MD: Center for Medicare and Medicaid Services. Retrieved from http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD10024.pdf.
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.
Essock, S., Frisman, L., & Kontos, N. (1998). Cost-effectiveness of assertive community treatment teams. American Journal of Orthopsychiatry, 68, 179–190.
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.
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.
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.
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.
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.
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.
Health Affairs Health Policy Brief: Patient-Centered Medical Homes. (2010, September 14) Retrieved from: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=25.
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.
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.
Kolbasovsky, A., & Futterman, R. (2007). Predicting psychiatric emergency room recidivism. Managed Care Interface, 20(4), 33–38.
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.
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.
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.
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.
National Conference of State Legislators (NCSL). (2013). State Budget Update: Fall 2013. Retrieved from: http://www.ncsl.org/documents/fiscal/fallsbu2013free.pdf.
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.
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.
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.
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.
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.
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.
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.
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.
SAMHSA. (2011, September 27). Health Homes and Individuals with Behavioral Health Issues SAMHSA’s guidance document affordable care act health home provision [Sec. 2703 & Sec. 19459(e)]. Retrieved from: http://beta.samhsa.gov/sites/default/files/guidancehealthhomesconsultationprocess.pdf.
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.
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.
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.
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.
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.
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.
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.
Wolff, N., Helminiak, T. W., & Diamond, R. J. (1995). Estimated societal costs of assertive community mental health care. Psychiatric Services, 46(9), 898–906.
Acknowledgements
This study was funded by a grant from the American Psychiatric Foundation (APF). While the main study was also funded by APF through a consortium of industry supporters, including Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Forest, Janssen, Pfizer and Wyeth, APIRE had complete discretion and control over the design and conduct of this study and analyses of the resulting database. Input or comments on this manuscript were not solicited or obtained from funders prior to submission. Findings from this study were presented at the 2012 APA Annual Meeting in Philadelphia, Pennsylvania, May 5–9, 2012 and at the 2012 Academy Health Meeting in Orlando, Florida, June 24–26, 2012.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
West, J.C., Rae, D.S., Mojtabai, R. et al. Planning Patient-Centered Health Homes for Medicaid Psychiatric Patients at Greatest Risk for Intensive Service Use. Community Ment Health J 51, 513–522 (2015). https://doi.org/10.1007/s10597-015-9834-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-015-9834-z