Search

AIMS: We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services' utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year. METHODS: We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed. RESULTS: CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = -1518, -391) and reduced days of detox utilization by about 1.0 days (95% CI = -1.9, -0.1) among HFS. CONCLUSION: Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients. [ABSTRACT FROM AUTHOR]

Reducing repeat use of costly inpatient services, such as inpatient withdrawal management, among Medicaid members is a target of healthcare reform. However, characteristics of frequent users of inpatient withdrawal management are understudied. We described the characteristics, service utilization, and costs of New York Medicaid clients who use withdrawal management services by analyzing data from Medicaid records from 2008. We examined follow-up care for individuals with different levels of repeat withdrawal management. We found 32,196 Medicaid withdrawal management patients with a total of 67,073 episodes and we divided patients into low (1 episode, n = 19,602), medium (2-3 episodes, n = 8619) and high (≥4 episodes, n = 3978) use categories. High users had almost 8 times the withdrawal management cost of low users. Similarly, they had 5 times more emergency department visits than low users. High users had high levels of homelessness (75%), 20% had HIV/AIDS, and 40% had Hepatitis. High withdrawal management users were less likely than low users to receive any follow-up treatment services. Medicaid clients with high utilization of inpatient withdrawal management are a small but costly population with poor follow-up rates to subsequent treatment services. They are a socially disenfranchised group that may benefit from targeted services to address their complex clinical needs. [ABSTRACT FROM AUTHOR]

Abstract: High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals <90th percentile of AODTx expenditures (n =41,054); high-cost clients in the top decile of AODTx expenditures (HC; n =5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals. [Copyright &y& Elsevier]

Introduction: New York State implemented a Health Homes (HH) care management program to facilitate access to health services for Medicaid enrollees with multiple chronic conditions. This study assessed the impact of HH on health care utilization outcomes among enrollees who have substance use disorder (SUD).Methods: Using HH enrollment data and Medicaid claims data 1 year before and after enrollment, this study compared HH enrollees who enrolled between 2012 and 2014 to a statistically matched comparison group created with propensity score methods. Analyses used generalized gamma models, logistic regression models, and difference-in-differences analyses to assess the impact of HH on general (all-cause) health care and SUD-related outpatient, emergency department (ED), hospitalization, and detoxification utilization as well as total Medicaid cost.Results: The sample consisted of 41,229 HH enrollees and a comparison group of 39,471 matched patients. HH-enrolled patients who had SUD utilized less SUD-related ED services (average marginal effect (AME) = -1.85; 95% CI = -2.45, -1.24), SUD-related hospitalizations (AME = -1.28; 95% CI: -1.64, -0.93), and detoxification services (AME = -1.30; 95% CI = -1.64, -0.96), relative to the comparison group during the 1 year post-HH enrollment. SUD-related outpatient visits did not change significantly (AME = -0.28; 95% CI = -0.76, 0.19) for enrollees, but general health care outpatient visits increased (AME = 1.63; 95% CI = 1.33, 1.93).Conclusion: These findings provide preliminary evidence that care management programs can decrease ED visits and hospitalizations among people with SUD. [ABSTRACT FROM AUTHOR]