John Robst1. 1. Department of Mental Health Law and Policy, Florida Mental Health Institute, University of South Florida, Tampa, FL 33612, USA. jrobst@fmhi.usf.edu
Abstract
OBJECTIVE: This article examines methods for identifying future high-cost cases of Medicaid-covered mental health care services. METHODS: Florida Medicaid claims data are used to compare methods based on prior cost, and concurrent and prospective diagnosis-based models. Individuals with prior year expenditures in the top decile or with predicted expenditures in the top decile from the diagnosis-based models were expected to be high-cost individuals. RESULTS: Individuals in the top decile of prior year costs averaged $13,684 (U.S. dollars) in costs in the following year with 50% remaining in the top decile of spending. Individuals classified as high cost by diagnosis-based models averaged $10,935 to $10,974, with 34% meeting the criteria for a high-cost case in the following year. CONCLUSION: In contrast to research on high-costs cases for physical health care, prior cost was superior to diagnosis-based models at identifying future high cases for mental health care.
OBJECTIVE: This article examines methods for identifying future high-cost cases of Medicaid-covered mental health care services. METHODS: Florida Medicaid claims data are used to compare methods based on prior cost, and concurrent and prospective diagnosis-based models. Individuals with prior year expenditures in the top decile or with predicted expenditures in the top decile from the diagnosis-based models were expected to be high-cost individuals. RESULTS: Individuals in the top decile of prior year costs averaged $13,684 (U.S. dollars) in costs in the following year with 50% remaining in the top decile of spending. Individuals classified as high cost by diagnosis-based models averaged $10,935 to $10,974, with 34% meeting the criteria for a high-cost case in the following year. CONCLUSION: In contrast to research on high-costs cases for physical health care, prior cost was superior to diagnosis-based models at identifying future high cases for mental health care.
Authors: Maureen Anderson; Crawford W Revie; Jacqueline M Quail; Walter Wodchis; Claire de Oliveira; Meriç Osman; Marilyn Baetz; J McClure; Henrik Stryhn; David Buckeridge; Cordell Neudorf Journal: Can J Public Health Date: 2018-06-28