The 130th Annual Meeting of APHA

Abstract #47187

Donald S. Shepard, PhD¹, Marilyn Daley, PhD¹, Richard H. Beinecke, PhD², Dominic Hodgkin, PhD¹, and Grant A. Ritter, PhD¹. (1) Schneider Institute for Health Policy, Heller School, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110, (2) Sawyer School of Management, Department of Public Management, Suffolk University, 8 Ashburton Place, Boston, MA 02108-2770

Although managed behavioral health care has achieved impressive cost reductions, its impact on quality has rarely been examined. Using claims for alcohol and drug treatment of Medicaid enrollees between Fiscal Year (FY) 1992 and FY1996, this study uses logistic regression to explore the impact of the first statewide public sector carve-out (Massachusetts MHMA) on two indicators of quality: rapid re-admissions to acute treatment services and continuity of care. Previously, we reported that overall access improved by 22% under MHMA while per enrollee spending declined dramatically (40%) between FY1992 and FY1996. In this study, we defined rapid re-admissions as admissions to a second episode of the same or a higher level of 24-hour care within 30 days following discharge from another 24-hour stay. We defined continuity as an admission to a lower level of care (outpatient, residential, or methadone) within 14 days of discharge from 24-hour care. We found that the likelihood of a 30-day re-admission increased by approximately 20% in the four years following MHMA, controlling for age, race, gender, primary diagnosis and eligibility status, suggesting quality may have fallen. Continuity of care, however, improved by 80%, and, after also accounting for substantial reductions in length of stay after MHMA, rapid readmissions decreased by 7%—both signs of improved quality. Re-admission rates were higher for older clients, males, whites, disabled clients and those with a primary diagnosis of alcohol or heroin use. Longer stays in the index facility and continuity to a lower level of care decreased re-admission rates. We conclude that this carve out has had mixed effects upon the quality of substance abuse treatment.

Learning Objectives: After attending this session, participants will be able to

• Identify strategies that managed behavioral health organizations use to reduce costs and maintain quality of care.
• Describe the relationship between client characteristics, program components and successful treatment outcomes.
• Understand the importance of continuity of care.

Keywords: Managed Care, Substance Abuse Treatment

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.