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News-Reports

Published on September 24, 2007

Author: WoodRock

Source: authorstream.com

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Differential Access to Services for Co-occurring Mental Health and Substance Abuse Disorders across Managed Care and Fee for Service Systems: A Multi-State Study:  Differential Access to Services for Co-occurring Mental Health and Substance Abuse Disorders across Managed Care and Fee for Service Systems: A Multi-State Study Roy M. Gabriel, Ph.D.1 Bentson H. McFarland, M.D.2 Brigid G. Zani, M.S.2 Lynn E. McCamant, M.S.2 1 RMC Research Corporation; Portland, Oregon 2 Oregon Health andamp; Science University; Portland, Oregon Co-Occurring Mental Health and Substance Abuse Disorders :  Co-Occurring Mental Health and Substance Abuse Disorders SAMHSA Report to Congress, 2002: COD the 'expectation' not the 'exception' SA Tx programs typically report 50%-75% of clients w/MH disorder MH clients also have elevated rates of substance abuse If Treated in Only One System or the Other:  If Treated in Only One System or the Other Worsening psychiatric symptoms Longer treatment stays More likely to be hospitalized Disproportionate representation in criminal justice system, homeless Medicaid Managed Care:  Medicaid Managed Care Majority of SA and MH Tx now publicly funded Medicaid behavioral health programs shifting away from fee for service (FFS) and toward managed care (MC) SAMHSA studies examining impact of shift to MC on SA and MH services separately Barriers to COD Services:  Barriers to COD Services Different need, referral criteria in SA and MH service systems Separate reporting and reimbursement systems Duplication of needed documentation Disincentive to Identify and Serve? SAMHSA Studies of Impact of Managed Care on Services to Vulnerable Populations, 1996–2000:  SAMHSA Studies of Impact of Managed Care on Services to Vulnerable Populations, 1996–2000 Adults w/Serious Mental Illness (SMI) SMI clients in 5 state systems (N = 2,318) Oregon, Pennsylvania, Virginia, Florida, Hawaii Adults in Substance Abuse Tx (SA) SA clients in 5 state systems (N = 2,424) Oregon, Washington, Massachusetts, Pennsylvania, New York Existing Data Sets from SAMHSA Studies:  Existing Data Sets from SAMHSA Studies Quasi-experimental comparison of adults receiving services in MC or FFS systems Structured interviews at treatment entry and 6 months later Included standardized measures SMI population: BSI, SF-12, ASI SA population: ASI, SF-12 Research Questions:  Research Questions For SMI clients What proportion of SMI clients received SA services during study period? What client characteristics were associated w/receipt of SA services? For SA clients What proportion of SA clients received MH services during study period? What client characteristics were associated w/receipt of MH services? Analysis Framework: Andersen Behavioral Model of Access to Health Care:  Analysis Framework: Andersen Behavioral Model of Access to Health Care Predisposing Characteristics Enabling Characteristics Need Characteristics Study Variables:  Study Variables Descriptive/Comparative Results: SMI Clients:  Descriptive/Comparative Results: SMI Clients Predominantly female (58%), non-White (55%), unemployed (86%), ave. 43 yrs old More likely to receive SA Tx in FFS (15%) than MC (9%) (p andlt; .001) MC sample reported more severe drug problems, MH symptoms, and poorer mental and physical health than FFS MC/FFS Comparisons varied significantly across states Descriptive/Comparative Results: SA Clients:  Descriptive/Comparative Results: SA Clients Predominantly male (60%), non-White (58%), unemployed (86%), ave. 38 yrs old More likely to receive MH Tx in MC (24%) than FFS (13%) (p andlt; .001) MC sample reported more severe MH problems and limitations in daily activities due to emotional problems. FFS sample reported more severe drug problems. MC/FFS comparisons varied significantly across states Odds Ratios: Predicting SA Tx Access among SMI Clients:  Odds Ratios: Predicting SA Tx Access among SMI Clients Odds Ratios: Predicting MH Tx Access among SA Clients:  Odds Ratios: Predicting MH Tx Access among SA Clients Conclusions:  Conclusions MC had differential impact on SA and MH services—Different systems Need factors are most predictive of concurrent SA or MH service access Several predisposing factors, even after controlling for need, suggestive of disparities in access Females more likely to access MH Tx Whites more likely to access MH Tx Substantial variation across states in MC/FFS sample comparisons—Different systems Study Limitations:  Study Limitations Clients not randomly assigned to MC/FFS conditions Study samples not selected as representative of each state’s clients Measures conceptually parallel, but not precisely the same, across SA and MH samples Concurrent SA/MH service use is self-reported, i.e., from client’s perspective Implications:  Implications Broad, sweeping policy shifts (from FFS to MC) can have differential effects on Medicaid sub-populations Variations among state systems key in understanding differences in MC/FFS groups and in access to SA/MH treatment Thanks to Principal Investigators of SAMHSA Studies:  Thanks to Principal Investigators of SAMHSA Studies SA Population Dr. Mary Jo Larson NE Research Inst. Dr. Frank McCorry NY State OASAS Dr. Thomas McLellan Tx Research Inst. Dr. Roy Gabriel RMC Research Corp. SMI Population Dr. Joseph Morrissey Univ. North Carolina Dr. Aileen Rothbard Univ. Pennsylvania Dr. David Shern Univ. South Florida Dr. Michael Wylie Univ. Hawaii Dr. Bentson McFarland Oregon Health andamp; Science Univ. Added Thanks to::  Added Thanks to: National Coordinating Center: Human Service Research Institute Dr. Virginia Mulkern Dr. Stephen Leff Mr. David Hughes SAMHSA GPOs Dr. Mady Chalk, (then) CSAT Ms. Frances Cotter, CSAT Dr. Jeff Buck, CMHS Questions, Further Information:  Questions, Further Information rgabriel@rmccorp.com

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