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Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

  • Xiaoling XiangEmail author
  • Randall Owen
  • F. L. Fredrik G. Langi
  • Kiyoshi Yamaki
  • Dale Mitchell
  • Tamar Heller
  • Amol Karmarkar
  • Dustin French
  • Neil Jordan
Original Article
  • 250 Downloads

Abstract

This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and $228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization.

Keywords

Medicaid Managed care Behavioral health Mental health 

Notes

Funding

This research was funded by the following sources: National Institutes of Health, grant# R24 P2CHD065702, and K01HD086290; and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Grant # 90AR5019, #90RT5023-01-00, #90RT5020-01-00, and #90RT5026-01-00.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10488_2018_892_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Michigan School of Social WorkAnn ArborUSA
  2. 2.Department of Disability and Human DevelopmentUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Division of Epidemiology and BiostatisticsUniversity of Illinois at Chicago School of Public HealthChicagoUSA
  4. 4.Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonUSA
  5. 5.Veterans Affairs Health Services Research and Development ServiceChicagoUSA
  6. 6.Department of OphthalmologyNorthwestern University Feinberg School of MedicineChicagoUSA
  7. 7.Department of Psychiatry & Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoUSA

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