Academic journal article Care Management Journals

Psychotherapeutic Home Intervention Program: Impact on Medicaid Readmission Rates

Academic journal article Care Management Journals

Psychotherapeutic Home Intervention Program: Impact on Medicaid Readmission Rates

Article excerpt

Records of 52 Medicaid managed care psychiatric patients engaged in a home intervention program (HIP) were analyzed to determine (a) if home-based intervention reduced a participant's readmission rates to an inpatient behavioral health facility and (b) if a negative relationship existed between total HIP sessions and readmissions following the implementation of home-based services. A paired t test comparing admissions 6 months prior to HIP with admissions 6 months after HIP demonstrated an average decrease of readmissions by 2.5 (p < .0001), or 86%. These results supported the hypothesis that HIP reduces participants' readmission rates.

Keywords: home-based psychological services; home intervention program; behavioral health care; Medicaid managed psychiatric care; reducing managed care costs

According to the most recent comprehensive study on behavioral health care expenditures, Medicaid is the largest single payer for services provided to the public sector (Mark, Buck, Dilonardo, Coffey, & Chalk, 2003). In 1997, total Medicaid spending for mental health and substance abuse services was estimated at 47.6 billion dollars (Mark et al., 2003). This estimate suggested that between 9.3% and 13% of all Medicaid costs at that time were related to behavioral health (Mark et al.). In contrast, total expenditures by private health insurance for behavioral health services accounted for 3.1% to 5.6% of their total claims (Harwood et al., 2003). Mark et al. reported that the larger proportion of Medicaid spending in comparison to private sector spending may be attributed to Medicaid's tendency to (a) offer generous coverage (which often includes unlimited benefits), (b) engage in minimal cost sharing, (c) have a higher proportion of members who use intensive services than private sector health plan members, and (d) enroll a large number of young adults, who demonstrate increased risk for behavioral health problems.

In reaction to increasing behavioral health care needs and expenses, many state Medicaid plans turned to managed care to reduce costs (Bouchery & Harwood, 2003; Forquer & Sabin, 2002). The Health Maintenance Organization Act of 1973 paved the way for restructuring the distribution and disbursement of private sector health care in the United States (Enthoven, 1993). Managed care for Medicaid began with a few pilot projects and partial delegations in the mid-1970s through the mid-1980s, gaining momentum until, by the late 1990s, approximately 40% of all Medicaid recipients were enrolled in private health maintenance organization (HMO) plans delegated by the recipient's state to manage his or her medical/behavioral health care (Rosenbaum, 1997; Zieman, 1998).

Despite criticism and opposition to Medicaid managed behavioral care (Hudson, 2001; Ross, 2000), programs such as the Nebraska Medicaid Managed Behavioral Healthcare Initiative (Bouchery & Harwood, 2003) achieved a reduction in high inpatient utilization rates and subsequent expenses without compromising quality of care. Other studies showed that similar initiatives in Colorado (Catalano, Libby, Snowden, & Cuellar, 2000), Hawaii (Pallak, 1994), Iowa (Ettner, Argeriou, McCarty, Dilonardo, & Liu, 2003), and Massachusetts (Beinecke & Lockhart, 1998; Nicholson, Young, & Simon, 1998) reduced overall program expenditures by decreasing inpatient utilization and increasing the use of less intensive and, therefore, less costly levels of care.

One way to reduce high inpatient behavioral health care utilization is to reduce readmission rates. In a quality profile of a plan geared towards reducing inpatient mental health admissions, the National Committee on Quality Assurance (NCQA, 2004) reported that patients most at risk for inpatient readmission tended to have two or more prior admissions and a history of hospitalization precipitated by noncompliance with treatment recommendations.

Psychiatric and social service professionals have offered several explanations for why some behavioral health patients frequently present for rehospitalization (Song, Biegel, & Johnsen, 1998; Yamada, Korman, & Hughes, 2000); Kent and Yellowlees (1994) studied 442 admissions of 50 patients with frequent readmissions to a mental health hospital and found that social factors contributed to almost 40% of the admissions, followed by psychiatric and physically related factors (31%), dangerousness to self or others (20. …

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