Online Program

Impact of multiple behavioral health and chronic medical co-morbidities on cost, utilization and outcomes among Maine Medicaid members

Tuesday, November 5, 2013

Elsie Freeman, MD MPH, Cutler Institute for Health and Social Policy, USM Muskie School of Public Service, Trevett, ME
John T. Devlin, MD, Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
Catherine McGuire, BA, Cutler Institute for Health Policy, Muskie School of Public Service, University of Southern Maine, Portland, ME
This longitudinal epidemiologic cohort study describes the impact of behavioral health disorders (BH) on cost, utilization, and outcomes for long-term Maine Medicaid enrollees while creating models, based on administrative and vital statistics data, for evaluation of health system re-design efforts being piloted in many states. 49% of 63,141 adult MaineCare members studied have at least one behavioral health (BH) disorder (mental illness, substance abuse, developmental disorders). Those with BH disorders have significantly higher rates of multiple medical co-morbidities (MCC); 40-50% of BH disordered persons have 3 or more medical co-morbidities versus 21% of the no BH group. Total cost is driven more by medical than BH costs for all but those with developmental disorders. Medical costs increase at each level of MCC for all, but having any BH disorder accounts for as much increase as 3 chronic medical conditions. Utilization of medical services (Emergency Room, hospital, 30 day readmission, avoidable hospitalization) is significantly higher in BH groups. For specific BH groups, increase in MCC also predicts increased BH utilization. Enrollees with BH disorders have higher rates of diabetes, diabetes complications, and studied longitudinally, worsening diabetes, new incidence of diabetes and death. Improved BH status reduces risk of developing more diabetes complications over time; decline in BH status and antipsychotic use are predictive of death among those with diabetes. Results demonstrate the importance of moving from single disease to person centered approaches in comparative effectiveness research on socio-economically challenged populations who have high rates of multiple BH and medical co-morbidities.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
Compare the prevalence of multiple medical comorbidites among Medicaid members with and without specific behavioral health disorders (mental illness, substance use disorders, dual diagnosis mental illness/substance abuse and cognitive impairments). Describe the impact of these multiple co-morbidities on medical and behavioral health care costs. Formulate the implications of these multi-morbidities for Health System Re-design: Health Homes, Accountable Care Organizations, Payment reform. Describe metrics from administrative data that can be used in comparative effectiveness research.

Keyword(s): Chronic Diseases, Mental Health Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator on the AHRQ funded R21 longitudinal epidemiologic cohort study of 63,000 long term Maine Medicaid members, from which the data being presented was derived. I am the lead author on the several publications being prepared on the results of this project:multimorbidities in socio-economically challenged populations; impact of co-morbid medical and behavioral health conditions on cost and utilization of care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.