Doctor consulting her female patient

Implementing parity for mental health and substance use treatment in Medicaid

Implementing parity for mental health and substance use treatment in Medicaid

Rates of mental health and substance use disorders (MHSUDs) in the adult Medicaid population are higher than for adults with Medicare or private health insurance. In this publication, HIP Investigator, Dr. Marguerite Burns et al. estimates the association between the implementation of parity in coverage for mental health and substance use disorder (MHSUD) services within the Medicaid program and MHSUD service use.

The author’s findings suggest that parity implementation in Medicaid could increase access to effective MHSUD services in a high‐need population.

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The Balanced Opioid Initiative

The Balanced Opioid Initiative

Rates of opioid prescribing tripled in the USA between 1999 and 2015 and were associated with significant increases in opioid misuse and overdose death. Roughly half of all opioids are prescribed in primary care. The challenge remains in implementing guidelines in a way that balances safety and effectiveness when following clinical guidelines recommending opioid prescribing practices.

HIP Investigator, Dr. Andy Quanbeck et al. designed a study to discover the most cost-effective sequence and combination of strategies for improving opioid prescribing practices in diverse primary care clinics. The results of the study promise to help understand how to cost effectively improve the implementation of evidence-based practices.

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Stumbling Into Adulthood: Learning From Depression While Growing Up

Stumbling Into Adulthood: Learning From Depression While Growing Up

In the United States, approximately 16% of adults aged 18 to 24 years report having been diagnosed with depression at some point in their lives. Growing attention to the specific impact of depression on people in their late teens and twenties corresponds with efforts in the behavioral and social sciences to more carefully delineate “emerging adulthood” either as a distinctive developmental phase, or simply as a protracted period between adolescence and adulthood created by contemporary social and economic conditions.

In this article, HIP Investigator Dr. Rachel Grob et al. examine how depression impacted respondent's transition from adolescence to emerging adulthood, and built their capacity to form a coherent identity and find a purpose in life.

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Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment

Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment

As of September 2019, 5 states have received federal waivers to temporarily suspend Medicaid eligibility for individuals who fail to pay required premiums. These periods, ranging from 3 to 12 months, are called lockouts, noneligibility periods, or restrictive reenrollment periods. Wisconsin received a Section 1115 waiver allowing the application of premiums enforced by lockouts among adults receiving transitional medical assistance (TMA), a federally required Medicaid category that provides time-limited coverage to parents and/or caretakers when their incomes increase to exceed the Medicaid program maximum. Wisconsin did not expand Medicaid under the Patient Protection and Affordable Care Act; TMA covers some individuals who would otherwise be eligible for the expansion.

A team of authors including HIP Investigator, Dr. Marguerite Burns conducted a survey study comparing the demographic characteristics, access to care, and health status of recent Medicaid enrollees in Wisconsin with and without experience of Medicaid lockouts.

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Holding hands

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

With the growing cost of health care in the United States, the need to improve efficiency and efficacy has become increasingly urgent. There has been a keen interest in developing interventions to effectively coordinate the typically fragmented care of patients with many comorbidities. Evaluation of such interventions is often challenging given their long-term nature and their differential effectiveness among different patients. Furthermore, care coordination interventions are often highly resource-intensive. Hence there is pressing need to identify which patients would benefit the most from a care coordination program. In this work, Dr. Jared Huling and HIP Investigators Dr. Menggang Yu and Dr. Maureen Smith introduced a subgroup identification procedure for long-term interventions whose effects are expected to change smoothly over time.

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Medical students in front of laptop

Broadening Medical Students' Exposure to the Range of Illness Experiences: A Pilot Curriculum Focused on Depression Education

Broadening Medical Students' Exposure to the Range of Illness Experiences: A Pilot Curriculum Focused on Depression Education

Exposing medical students to a broad range of illness experiences is crucial for teaching them to practice patient-centered care, but students often have limited interaction with patients with diverse illness presentations. In this pilot, Dr. Rachel Grob et. al developed, implemented, and evaluated a self-directed online curriculum followed by a small group discussion focused on depression education. The curriculum was based on a module created using the Database of Individual Patients’ Experiences methodology.

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Association of anxiety and depression with hypertension control

Association of anxiety and depression with hypertension control

This study by Dr. Heather Johnson's team aimed to evaluate rates and predictors of incident hypertension control among patients with anxiety and/or depression compared to patients without either mental health diagnosis. The 4-year retrospective analysis included patients over the age of 18 with hypertension. Those with anxiety and/or depression demonstrated more primary care and specialty visits than those without either condition. Other association of hypertension control included female gender, absence of tobacco use, Medicaid use, and a higher Adjusted Clinical Group Risk Score.

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Visit patterns for severe mental illness with implementation of integrated care

Visit patterns for severe mental illness with implementation of integrated care

This retrospective cohort pilot study by Meghan Fondow et al. examined visit patterns for over 1,000 patients with severe mental illness using EHR data from two federally qualified health centers. During the intervention period of a model that integrated behavioral health services with primary care, there was a significant increase in the proportion of visits per month. After the intervention, this rate declined but remained above pre-intervention period.

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Pills in a row

Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar 1 disorder among dually enrolled beneficiaries

Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar 1 disorder among dually enrolled beneficiaries

Marguerite Burns et al. examined the effect of an insurance coverage transition that occured in 2006, which shifted coverage from Medicaid to Medicare Part D private drug plans for individuals who were enrolled in both programs. In this study, the authors investigated the receipt of guideline-concordant pharmacotherapy for biopolar I disorder after the transition and found that 16 months after the transition to Part D, the number of people with any recommended use of anti-manic drugs was higher than expected, and the number of ED visits per month temporarily increased by 19% immediately after the transition.

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Pills coming out of bottle

The effect of Medicare Part D on the quality of pharmacotherapy for bipolar 1 disorder among dually enrolled beneficiaries

The effect of Medicare Part D on the quality of pharmacotherapy for bipolar 1 disorder among dually enrolled beneficiaries

In this article, Dr. Marguerite Burns et al. sought to determine whether the shift in 2006 from Medicaid coverage for medications to Medicare Part D for dually enrolled beneficiares affected psychiatric medication management. They examined Medicaid and Medicare administrative data and the effect of the coverage transition on receipt of guideline-concordant antimanic medication, antidepressant monotheray, and emergency department visits, and found that 16 months after the transition to Part D, the proportion of the population with any recommended use of antimanic drugs was 3.1% higher than expected, and the proportion of beneficiaries with antidepressant monotherapy was 2.1% lower than expected. The number of ED visits temporarily increased by 19% immediately post-transition.

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