Medicaid Program Ineffective in Improving Hospital Readmissions

People with severe mental illness die up to 25 years earlier than people in the general population, in part due to high levels of comorbid physical health conditions such as cancer, diabetes and heart disease. Research has demonstrated that fragmented medical care for people with severe mental illness is a large factor contributing to this incredible disparity in life expectancy for this population.

As part of a waiver process as a result of the Affordable Care Act of 2008, the Centers for Medicare and Medicare Services approved 19 states to create behavioral health home programs for Medicaid beneficiaries with serious mental illness. The goal of these programs is to improve care coordination and medical care management for people with serious mental illness, leading to improved quality of care and reducing negative outcomes.

Researchers from Johns Hopkins Center for Mental Health and Addiction Policy in Baltimore evaluated the impact of Maryland’s behavioral health home for people with serious mental illness, the results of which were published in Health Services Research this fall. The researchers sought to evaluate the effectiveness of Maryland’s behavioral health home on follow-up care post-hospital discharge and hospital readmission rates, two indicators of adequate care coordination and transitional care. People with serious mental illness have higher hospital readmission rates than the general population, and timely follow-up care in the community has been shown to reduce the risk of rehospitalization, according to previous research.

Utilizing Maryland Medicaid claim data, the researchers’ sample included more than 12,000 people who utilized mental health services between October 2012 and December 2016. Maryland began implementing their behavioral health home in October 2013, so the researchers were able to examine the impact of enrollment on behavioral health homes on follow-up care and readmission rates.

Their findings were surprising. Although the results indicate that the behavioral health home had modest impacts on improving follow-up care among individuals with serious mental illness who were hospitalized, this did not translate to reducing the risk of readmission among this population. Enrollment in a behavioral health home was associated with a 3.8% increased probability of having mental health follow-up care within seven days of discharge from a hospitalization, and 1.9% increased probability of having a general medical follow-up care within seven days of discharge from a general medical hospitalization, according to their results.

The study authors conclude that “findings from this study indicate that improved transitional care may not be sufficient to reduce readmission risk. Readmissions are complex, and other factors, such as other policy efforts to reduce readmissions, individual comorbidity and complexity, and community treatment infrastructure, influence readmission risk; transitional care therefore can be one among many important factors.”

Previous research has suggested that there are significant implementation challenges associated with behavioral health homes that impacts their effects on care utilization and quality and each state program has had variable success in maintaining their core elements. Therefore, future work should focus on strengthening the implementation of behavioral health homes to better understand their potential in improving outcomes for people with serious mental illness.

By Elizabeth Hancq - Dec 1, 2020

References:

Kennedy-Hendricks, A., et al. (2020, October). Behavioral health home impact on transitional care and readmissions among adults with serious mental illness. Health Services Research.