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Brown JD, Stewart KA, Miller RL, Dehus E, Rose T, DeWitt K, Chapman R, Wishon A, Breslau J, Dey J, Jacobus-Kantor L. Impacts of the Certified Community Behavioral Health Clinic Demonstration on Emergency Department Visits and Hospitalizations. Psychiatr Serv 2023; 74:911-920. [PMID: 36916061 DOI: 10.1176/appi.ps.20220410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The Certified Community Behavioral Health Clinic (CCBHC) demonstration is designed to increase access to comprehensive ambulatory care and crisis services, which may reduce emergency department (ED) visits and hospitalizations. This study examined whether the demonstration had an impact on ED visits and hospitalizations in Missouri, Oklahoma, and Pennsylvania. METHODS This difference-in-differences analysis used Medicaid claims data from 2015 to 2019 to examine service use during a 12-month baseline period and the first 24 months of the demonstration for beneficiaries who received care from CCBHCs and beneficiaries who received care from other behavioral health clinics in the same state, representing care as usual. Propensity score methods were used to develop treatment and comparison groups with similar characteristics. RESULTS In Pennsylvania and Oklahoma, beneficiaries who received care from CCBHCs had a statistically significant reduction in the average number of behavioral health ED visits, relative to the comparison group (13% and 11% reductions, respectively); no impact on ED visits in Missouri was observed. The demonstration was associated with a statistically significant reduction in all-cause hospitalizations in Oklahoma, when the analysis used a 2-year rather than a 1-year baseline period, and also in Pennsylvania, when hospitalizations were truncated at the 98th percentile to exclude beneficiaries with outlier hospitalization rates. CONCLUSIONS The CCBHC demonstration reduced behavioral health ED visits in two states, and the study also revealed some evidence of reductions in hospitalizations.
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Affiliation(s)
- Jonathan D Brown
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Kate A Stewart
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Rachel L Miller
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Eric Dehus
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Tyler Rose
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Kathryn DeWitt
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Richard Chapman
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Allison Wishon
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Joshua Breslau
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Judith Dey
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Laura Jacobus-Kantor
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
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Benson NM, Myong C, Newhouse JP, Fung V, Hsu J. Psychiatrist Participation in Private Health Insurance Markets: Paucity in the Land of Plenty. Psychiatr Serv 2020; 71:1232-1238. [PMID: 32811283 PMCID: PMC7708395 DOI: 10.1176/appi.ps.202000022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Access to specialty mental health care may be poor because many psychiatrists do not accept health insurance reimbursement, whereas many patients rely on insurance to help pay for care. The objective of this study was to examine the extent of participation in private insurance by licensed psychiatrists. METHODS Using 2013 Massachusetts licensing data and the All-Payer Claims Database (APCD), the authors performed a cross-sectional analysis of licensed psychiatrists in Massachusetts. The fraction of psychiatrists who filed insurance claims, number of unique patients with insurance claims per psychiatrist, and physician characteristics associated with insurance participation were evaluated. RESULTS In 2013, Massachusetts had 2,348 licensed psychiatrists. Overall, 79% (N=1,843) had at least one paid claim for an outpatient visit in the APCD, but only 6% (N=151) had claims for at least 300 patients per year (a full caseload). Psychiatrists had a median of 18 patients with claims (mean=73). Compared with psychiatrists 30-39 years since medical school graduation, those within 19 years since graduation were less likely to bill for an outpatient (7-19 years, odds ratio [OR]=0.67, 95% confidence interval [CI]=0.47-0.94) and less likely to have claims for ≥300 patients per year (7-19 years, OR=0.49, 95% CI=0.29-0.83). Participation varied across insurance types (93% for group commercial plans versus 33% for Medicaid managed care plans). CONCLUSIONS Among Massachusetts psychiatrists, participation in the private insurance market appears to be limited. Older psychiatrists are more likely to participate, and patients' access to psychiatrists who accept insurance could worsen as these psychiatrists retire.
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Affiliation(s)
- Nicole M Benson
- McLean Hospital, Belmont, Massachusetts (Benson); Department of Psychiatry (Benson), and Mongan Institute (Myong, Fung, Hsu), Massachusetts General Hospital, Boston; Department of Health Care Policy (Newhouse), and Department of Medicine (Fung, Hsu), Harvard Medical School, Boston; National Bureau of Economic Research, Cambridge, Massachusetts (Newhouse)
| | - Catherine Myong
- McLean Hospital, Belmont, Massachusetts (Benson); Department of Psychiatry (Benson), and Mongan Institute (Myong, Fung, Hsu), Massachusetts General Hospital, Boston; Department of Health Care Policy (Newhouse), and Department of Medicine (Fung, Hsu), Harvard Medical School, Boston; National Bureau of Economic Research, Cambridge, Massachusetts (Newhouse)
| | - Joseph P Newhouse
- McLean Hospital, Belmont, Massachusetts (Benson); Department of Psychiatry (Benson), and Mongan Institute (Myong, Fung, Hsu), Massachusetts General Hospital, Boston; Department of Health Care Policy (Newhouse), and Department of Medicine (Fung, Hsu), Harvard Medical School, Boston; National Bureau of Economic Research, Cambridge, Massachusetts (Newhouse)
| | - Vicki Fung
- McLean Hospital, Belmont, Massachusetts (Benson); Department of Psychiatry (Benson), and Mongan Institute (Myong, Fung, Hsu), Massachusetts General Hospital, Boston; Department of Health Care Policy (Newhouse), and Department of Medicine (Fung, Hsu), Harvard Medical School, Boston; National Bureau of Economic Research, Cambridge, Massachusetts (Newhouse)
| | - John Hsu
- McLean Hospital, Belmont, Massachusetts (Benson); Department of Psychiatry (Benson), and Mongan Institute (Myong, Fung, Hsu), Massachusetts General Hospital, Boston; Department of Health Care Policy (Newhouse), and Department of Medicine (Fung, Hsu), Harvard Medical School, Boston; National Bureau of Economic Research, Cambridge, Massachusetts (Newhouse)
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Yang BK, Burcu M, Safer DJ, Trinkoff AM, Zito JM. Comparing Nurse Practitioner and Physician Prescribing of Psychotropic Medications for Medicaid-Insured Youths. J Child Adolesc Psychopharmacol 2018; 28:166-172. [PMID: 29641238 DOI: 10.1089/cap.2017.0112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To describe psychotropic medication prescribing practices of nurse practitioners (NP) and physicians for Medicaid-insured youths in 2012-2014 in a mid-Atlantic state where NP independent prescribing is authorized. Method: From annual computerized administrative claims data in a mid-Atlantic state, we analyzed 1,034,798 dispensed psychotropic medications prescribed by NPs and physicians for 61,526 continuously enrolled Medicaid-insured youths aged 2-17 years. Demographic and clinical characteristics of psychotropic medication users were compared for youths who received psychotropic medication dispensings by NP-only, physician-only, or by both providers using descriptive statistics and generalized estimating equations. We then characterized psychotropic medication prescribing practices by providers within each specialty. Results: From 2012 to 2014, the number of psychotropic medication dispensings increased from 346,922 to 349,080. There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively). Youths diagnosed with depression or anxiety were more commonly treated by NP-only than by physician-only (AOR = 1.33, 95% CI = 1.24-1.43), whereas youths with two or more psychiatric comorbidities were significantly more commonly treated by both NP and physician providers (AOR = 1.44, 95% CI = 1.39-1.50). Psychiatric specialists prescribed the bulk of antidepressants (82.0%) and lithium (92.3%), with much lower prescribing by non-psychiatric specialists (18.0% and 7.7%, respectively). Antipsychotic orders originated from psychiatric specialists 7.4 times more than from their non-psychiatric specialty counterparts, whether physician or NP. Conclusions: NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention.
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Affiliation(s)
- Bo Kyum Yang
- Department of Interprofessional Health Studies, Towson University, Towson, Maryland
| | - Mehmet Burcu
- Pharmaceutical Health Services Research Department, University of Maryland, Baltimore, Maryland
| | - Daniel J Safer
- Department of Psychiatry and Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alison M Trinkoff
- Family and Community Health Department, University of Maryland School of Nursing, Baltimore, Maryland
| | - Julie M Zito
- Departments of Pharmaceutical Health Services Research and Psychiatry, University of Maryland, Baltimore, Maryland
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Adefolarin A, Arulogun O. Need Assessment for Health Education Service Provision on Maternal Depression Among Primary Health Care Service Providers. ARCHIVES OF BASIC AND APPLIED MEDICINE 2018; 6:27-33. [PMID: 30258981 PMCID: PMC6152917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Maternal depression is gradually becoming a prevailing condition among women of reproductive age in Nigeria but there are little efforts towards addressing this problem. Need assessment for health education service provision on maternal depression therefore becomes necessary. Hence, this study assessed the needs of Primary Health Care (PHC) workers regarding the provision of routine health talk on maternal depression. This study was descriptive in design and it adopted a mixed method. Four Key Informant Interviews (KII) and a survey which involved 100 Health Workers (HWs) were carried out. KII participants were purposively selected from the 4 LGAs where volunteers were found and the 100 HWs were conveniently selected from all the Comprehensive Clinics (CCs) in the 5 LGAs. A KII guide and structured questionnaire were used to collect data and data were analyzed thematically, with descriptive statistics and chi-square. The mean age of the key informant's interviewees was 54±6.1years and the mean age of the survey respondents was 42±5.2 years. The interviewees identified HWs' inability to communicate maternal depression to the service users in appropriate local terms and non-availability of Information, Education and Communication (IEC) materials as barriers to giving health talk on maternal depression. Survey respondents identified certain needs with a statistical significance across cadres. Eighty-three (88.3%) identified training need, education aid materials 61.7%; p<0.05, maternal depression health education guide 27.7%; p<0.05 and need for more staff 22.3%. Training need, non-availability of maternal depression targeted educational materials and the need for more staff were the primary identified needs.
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Affiliation(s)
- A.O. Adefolarin
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan
- Department of Psychiatry, College of Medicine, University of Ibadan. Ibadan, Nigeria
| | - O.S. Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan
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