Clinical Topic Review 2013 - Behavioral Health Screening Among MassHealth Children and Adolescents

Results from the 2013 evaluation suggest that the Children’s Behavioral Health Initiative had a large impact on formal behavioral health screening and treatment utilization among children and adolescents enrolled in MassHealth

Disparities in routine breast cancer screening for medicaid managed care members with a work-limiting disability

Objective: Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability. Methods: Individual-level data were obtained for women enrolled in Massachusetts Medicaid Managed Care plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screening measure (n=35,171). Disability status was determined from Medicaid eligibility records. Mammography screening was modeled using multivariate logistic regression. Separate models for women with and without a disability were also estimated. Results: Although unadjusted breast cancer screening rates were roughly equal for women with and without disability, after adjusting for confounders disability status had a significant negative association with screening mammography (OR=0.74; p Conclusion: Nationwide, rates of routine mammography for Medicaid managed care plans averaged below 50% in 2006. Given that a majority of eligible women served by Medicaid have disabilities, and studies have shown that women with disabilities are more likely to be diagnosed with late stage disease, a focus on improving rates of screening for women with disabilities is overdue

Who is most vulnerable? Gender differences among the homeless

This dissertation examines the gender differences among the homeless. Although women with dependent children comprise the fastest growing subgroup among the homeless population, most of the homeless are still single adults. The vast majority of these single adults are men, though the number of single women has increased notably in recent years. The second purpose of the dissertation is to examine who is most vulnerable to homelessness. The analysis strategy was to examine the literal homeless comparing three subgroups, unattached men, unattached women, and women with dependent children, and then to examine the very poor who are housed comparing the corresponding subgroups. Comparisons were made of the characteristics of and the financial and social resources available to the literal homeless and the domiciled poor. The descriptive analysis of the gender differences among the homeless are based on empirical data collected from the Chicago Homeless Study in 1985. Data on unattached men and women who are housed come from the General Assistance Study conducted in Chicago in 1984 and data on women with dependent children come from a 1985 study of welfare families in Chicago. The findings indicate that homeless men are poorer, more disabled, and more socially isolated than homeless women. In particular, their levels of poverty, disability, and social isolation are substantially higher than that of homeless women with dependent children. Their high levels of disabilities make it extremely difficult for the homeless men to find employment or to reciprocate in social relations. Most of them have had their social networks destroyed or exhausted and few receive needed social services. The absence of social and public resources means that homeless men have difficulty extricating themselves from homelessness. For these reasons, the men are more vulnerable to chronic homelessness. There is a subset of homeless single women whose conditions are not very different from homeless men. Women with dependent children have the best chances of extricating themselves from homelessness. Policy implications are discussed

Behavioral Health Screening among Massachusetts Children Receiving Medicaid

OBJECTIVE: To assess the impact of a Massachusetts Medicaid policy change (the Children\u27s Behavioral Health Initiative; CBHI, which required and reimbursed behavioral health [BH] screening with standardized tools at well child visits and developed intensive home- and community-based BH services) on primary care practice examining the relationship of BH screening to subsequent BH service utilization. STUDY DESIGN: Using a repeated cross-sectional design, our 2010 and 2012 Medicaid study populations each included 2000 children/adolescents under the age of 21 years. For each year, the population was randomly selected and stratified into 4 age groups, with 500 members selected per group. Two data sources were used: medical records and Medicaid claims. RESULTS: The CBHI had a large impact on formal BH screening and treatment utilization among children/adolescents enrolled in Medicaid. Screening increased substantially (73%: 2010; 74%: 2012) since the baseline/premandate period (2007) when only 4% of well child visits included a formal screen. BH utilization increased among those formally screened but decreased among those with informal assessments. CONCLUSIONS: CBHI implementation transformed the relationship between primary care and BH services. Changes in regulation and payment resulted in widespread BH screening in Massachusetts primary care practices caring for children/adolescents on Medicaid

Predictors of prenatal and postpartum care adequacy in a medicaid managed care population

PURPOSE: To examine factors affecting prenatal and postpartum care for an insured, but vulnerable, population. METHODS: Individual-level data on three measures of care adequacy were obtained for Massachusetts Medicaid Managed Care women who met the National Committee on Quality Assurance\u27s Healthcare Effectiveness Data and Information Set denominator criteria for the prenatal and postpartum care measures in 2007 (n = 1,882). We modeled individual compliance with each measure separately as a binomial logistic function with individual and neighborhood characteristics, provider type, and health plan as explanatory variables. FINDINGS: In our sample, 85% of women initiated care in the first trimester, but only 62% met the goal of receiving more than 80% of the recommended number of prenatal visits. Just 60% had a timely postpartum care visit. Having a diagnosis of substance abuse or dependence reduced the odds of meeting all measures. Women with disabilities were less likely to attain two of the three measures of adequate care, as were women with other children in the household. Women who enrolled in Medicaid in the first trimester were more likely to receive the recommended number of prenatal visits than those who were enrolled before pregnancy. CONCLUSION: Given the importance of prenatal and postpartum care for maternal and child health and the recent national declining trend in timely care, initiatives to improve rates of timely and adequate care are crucial and must include components tailored toward particularly vulnerable subpopulations. All rights reserved

The effect of a telephone-based health coaching disease management program on Medicaid members with chronic conditions

BACKGROUND: Despite the growing popularity of disease management programs for chronic conditions, evidence regarding the effect of these programs has been mixed. In addition, few peer-reviewed studies have examined the effect of these programs on publicly insured populations. OBJECTIVES: To examine the effect of a telephone-based health coaching disease management program on healthcare utilization and expenditures in Medicaid members with chronic conditions. RESEARCH DESIGN: Using a difference-in-differences analysis, we examined changes in hospitalizations, emergency department (ED) visits, ambulatory care visits, and Medicaid expenditures among program members for 1 year before and 2 years after their enrollment compared with a matched comparison group. SUBJECTS: Medicaid members aged 18 to 64 with a diagnosis of qualifying chronic conditions and 2 acute health service events of hospitalizations and/or ED visits within a 12-month period. RESULTS: Changes in acute hospitalizations, ambulatory care visits, and Medicaid expenditures before and after program enrollment were similar between the 2 study groups. However, during the second year after enrollment, program members had a significantly smaller decrease in ED visits than the comparisons (8% in program members and 23% in comparisons, P value=0.03). CONCLUSIONS: Compared with a matched comparison group, the telephone-based health coaching disease management program did not demonstrate significant effects on healthcare utilization and expenditures in Medicaid members with chronic conditions