Beyond the Water's Edge: Charting the Course of Managed Care for People with Disabilities - Conference Resource Book. Severely Mentally Ill HMO Members

11/01/1996

Bentson H. McFarland, M.D., Ph.D.
Bentson McFarland is Professor of Psychiatry, Public Health and Preventive Medicine at Oregon Health Sciences University and Adjunct Investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon. He received his M.D. degree and a Ph.D. in biostatistics from the University of Washington in Seattle. He conducts research on mental health services, pharmacoeconomics, and pharmacoepidemiology.

RESEARCHERS

  • Bentson H. McFarland, M.D., Ph.D.
  • Richard E. Johnson, Ph.D.
  • Mark C. Hornbrook, Ph.D.

BACKGROUND: MEDICAL OUTCOMES STUDY

  • Depressed psychiatric patients disenrolled from HMO sooner than comparable fee for service patients
  • No HMO controls

OBJECTIVES

  • Enrollment duration
  • Service use
  • Cost of care

SEVERELY MENTALLY ILL HMO MEMBERS

  • Specialty mental health users
  • Diagnosis of schizophrenia or bipolar disorder
  • Cohort #1
    • Outpatient records 1986-1987
    • Follow-up through 1990
  • Cohort #2
    • Inpatient records 1990-1991
    • Follow-up through 1995

CONTROLS (AGE AND SEX MATCHED)

  • Membership
  • Pharmacy users
  • Diabetic patients

SEVERELY MENTALLY ILL SURJECTS (COHORT #1)

  • N = 250
  • Age = 32
  • Male = 50%
  • Schizophrenia = 32%
  • Prior state hospital use = 41%

PREDICTORS OF LONGER ENROLLMENT FOR SEVERELY MENTALLY ILL SUBJECTS (COHORT #1)

  • Prior enrollment duration (p < .006 )
  • Community mental health center use (p < .05 )

Note: HMO costs of care not predictive of enrollment duration

CONCLUSIONS

  • Severely mentally ill HMO members maintain HMO enrollment (as do other ill HMO members)
  • Community mental health center use associated with longer enrollment
  • HMO costs of care not related to enrollment duration
TABLE 1. Utilization and HMO Costs During Follow-Up (Cohort #1)
  Severely Mentally Ill Controls
Community mental health center 40% 5%
State hospital 12% 1%
Exceeded mental health benefit 12% 0%

 

TABLE 2. Enrollment Duration (Cohort #1)
  Days in HMO
Diabetic patients 1,424
Severely mentally ill 1,263
Pharmacy controls 1,236
Membership controls 1,023

 

TABLE 3. Enrollment Duration (Cohort #2)
  Days in HMO
Diabetic patients 1,256
Severely mentally ill 1,158
Pharmacy controls 861
Membership controls 175

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