Recorded presentation

Roger A. Boothroyd, PhD¹, Paul Stiles², Kelley Dhont, MS³, and Pamela F. Beiler, MSW¹. (1) Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 North Bruce B. Downs Blvd, Tampa, FL 33612, 813-974-1915, boothroyd@fmhi.usf.edu, (2) Florida Mental Health Institute / Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL 33612, (3) Louis de la Part Florida mental Health Institute, University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33612

This presentation summarizes whether adherence to recommended practice guidelines: 1) is associated with financing strategy, 2) improves clinical outcomes, and 3) is cost-effective. Analyses are based on interviews with 475 adult Medicaid enrollees diagnosed with depression or schizophrenia and their administrative service use data. Enrollees were categorized into four diagnosis (i.e., schizophrenia versus depression)/severity (i.e., acute versus chronic) categories and their Medicaid-reimbursed mental health services were assessed against APA recommended practice guidelines. Overall 57% of the enrollees received recommended care although this differed by diagnosis/severity category. Individuals in the fee-for-service (FFS) condition were significantly more likely to receive guideline consistent treatment compared to enrollees in two managed care conditions. Change in enrollees’ clinical status was not significantly associated with adherence to practice guidelines. Costs of health-related services (i.e., general health, mental health, vision, & dental) were significantly higher for individuals with schizophrenia who received treatment comporting with practice guidelines. No significant difference was found for health-related costs among individuals diagnosed with major depression. In terms of total social costs (i.e., costs from all sectors), however, no significant differences existed for individuals with depression or schizophrenia, irrespective of whether they received treatment adhering to practice guidelines. We conclude that providers prescribe treatment to persons with mental disorders that comports with recommended standards given they represent the professional consensus regarding preferred treatment practices and because the total social costs for these individuals is similar irrespective of whether recommended treatment is provided. The question is not total societal costs, but rather who pays.

Learning Objectives: