Sachini N Bandara1, Alene Kennedy-Hendricks2, Elizabeth A Stuart3, Colleen L Barry2, Michael T Abrams4, Gail L Daumit5, Emma E McGinty2. 1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21205, United States of America; Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21205, United States of America. Electronic address: sbandara@jhu.edu. 2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21205, United States of America; Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21205, United States of America. 3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21205, United States of America; Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21205, United States of America; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States of America; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States of America. 4. National Quality Forum, 1030 15th Street NW, Washington, DC 2005, United States of America. 5. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21205, United States of America; Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21205, United States of America; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States of America; Division of General Internal Medicine, Johns Hopkins University School of Medicine 2024 East Monument Street, Baltimore, MD 21287, United States of America.
Abstract
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.
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.
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