Online Program

Screening and brief intervention among working-age Medicaid beneficiaries with diabetes in Wisconsin: Impacts on healthcare utilization

Wednesday, November 4, 2015 : 9:10 a.m. - 9:30 a.m.

Jason Paltzer, PhD, MPH, Public Health, Grand Canyon University, Laveen, AZ

Background:  Risky substance use has shown to increase the healthcare utilization and costs among individuals with co-occurring diabetes.  Screening and brief intervention (SBI) has shown to be effective in reducing risky substance use as well as high-cost emergency room and inpatient utilization. 

Methods:  The effectiveness of SBI was studied among Medicaid beneficiaries with diabetes in Wisconsin.  A pre-post with comparison group design was used to assess the changes in utilization associated with receiving SBI services compared to receiving treatment-as-usual.  Participants were stratified by Medicaid-Medicare dual eligibility status.  Healthcare utilization was measured as outpatient days, inpatient days, inpatient admissions, and emergency room admissions.  Utilization and health status were ascertained using individual Medicaid fee-for-service and encounter payment claims from 2006 to 2011.  SBI services were provided to non-treatment-seeking adults through the SAMHSA-funded Wisconsin Initiative to Promote Healthy Lifestyles.  A total of 1,947 beneficiaries with diabetes were included in the study.  Multiple regression models were used to assess utilization changes.

Results:  Non-dually eligible Medicaid beneficiaries (n=1,159) with diabetes showed no significant changes in healthcare utilization after receiving substance use SBI services compared to individuals receiving treatment-as-usual.  Dually eligible Medicaid-Medicare beneficiaries (n=788) with diabetes who received SBI services significantly reduced their annual inpatient utilization by 2.24 days (95% CI, 0.46 - 4.03) and inpatient admissions by 0.25 admissions (95% CI, 0.09 - 0.42).  Outpatient utilization increased among dually eligible beneficiaries by 2.75 days annually (95% CI, -2.21 - 7.71).  The best estimate of annual healthcare savings over two years associated with SBI is $2,844 per dually-eligible patient with diabetes. 

Conclusions: SBI among working-age dually-eligible Medicaid patients with diabetes was associated with a significant reduction in inpatient utilization.  These results suggest that implementing substance use SBI services among individuals with diabetes could result is significant healthcare cost savings, especially among those with dual eligibility status.

Learning Areas:

Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Social and behavioral sciences

Learning Objectives:
Assess changes in healthcare utilization associated with substance use screening and brief intervention among low-income patients with diabetes. Discuss the use of screening and brief intervention as an effective intervention for reducing risky substance use and associated high-cost healthcare utilization.

Keyword(s): Diabetes, Health Care Costs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator on a series of studies evaluating the effect of substance use screening and brief intervention on healthcare utilization in Wisconsin. I have been the research assistant and first author of a peer-reviewed paper based on a federally funded grant project focusing on substance abuse prevention and policy. I was a co-principal of a study funded by the University of Wisconsin Global Health Institute evaluating child-health related quality of life measurement.
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.