Developing Quality Measures for Medicaid Beneficiaries with Schizophrenia: Final Report. Appendix E. Pilot-testing Results

01/30/2012

TABLE E.1. Enrollee Information and Selected SMI Conditions by State
State Total
FFS
FFS
Disabled
FFS Disabled
& Non-
Dually Eligible
Meet All
Inclusion Criteriaa
Schizophreniab Bipolar
Disorderc
Schizophrenia or
Bipolar Disorderd
Schizophrenia and
Bipolar Disordere
N N N N N   Percent   N   Percent   N   Percent   N   Percent  
AL 903,809 210,887 111,630 52,351 4,071 7.8 1,201 2.3 5,067 9.7 205 0.4
AK 126,203 15,747 8,510 2,670 270 10.1 114 4.3 379 14.2 5 0.2
CA 10,654,123 1,128,827 628,773 348,599 36,571 10.5 12,404 3.6 45,920 13.2 3,055 0.9
CT 465,746 68,349 30,397 19,875 2,699 13.6 1,215 6.1 3,629 18.3 285 1.4
DC 77,172 34,998 23,741 12,700 1,716 13.5 703 5.5 2,239 17.6 180 1.4
GA 1,104,108 282,632 151,295 66,548 6,177 9.3 1,870 2.8 7,617 11.4 430 0.6
ID 229,423 36,382 20,555 7,613 781 10.3 648 8.5 1,329 17.5 100 1.3
IL 2,380,314 344,733 171,810 103,202 12,781 12.4 5,580 5.4 15,956 15.5 2,405 2.3
IN 970,830 148,624 72,925 38,034 3,198 8.4 1,793 4.7 4,778 12.6 213 0.6
IA 479,755 71,302 33,342 14,413 1,376 9.5 675 4.7 1,907 13.2 144 1.0
LA 1,155,231 197,309 124,592 58,473 4,314 7.4 1,180 2.0 5,258 9.0 236 0.4
MD 835,727 138,739 84,577 41,442 4,340 10.5 2,718 6.6 6,495 15.7 563 1.4
MO 721,719 187,957 99,510 55,677 4,775 8.6 3,910 7.0 8,021 14.4 664 1.2
MS 745,543 171,082 93,910 41,175 3,377 8.2 803 2.0 4,039 9.8 141 0.3
NH 144,366 22,315 8,848 4,682 374 8.0 228 4.9 581 12.4 21 0.4
NC 1,655,892 283,473 153,256 66,404 5,670 8.5 2,777 4.2 7,932 11.9 515 0.8
ND 73,449 10,883 4,594 2,041 219 10.7 59 2.9 268 13.1 10 0.5
NV 197,548 39,964 23,054 8,567 749 8.7 348 4.1 1,039 12.1 58 0.7
OK 783,335 103,287 55,442 27,102 2,600 9.6 1,330 4.9 3,720 13.7 210 0.8
SD 131,924 19,026 8,709 3,591 279 7.8 73 2.0 346 9.6 6 0.2
WV 289,435 113,811 72,220 41,844 1,933 4.6 2,090 5.0 3,806 9.1 217 0.5
WY 77,782 9,869 5,179 2,120 142 6.7 72 3.4 203 9.6 11 0.5
Total     24,203,434     3,640,196     1,986,869     1,019,123     98,412   9.7   41,791   4.1   130,529   12.8   9,674   0.9
SOURCE: Mathematica analysis of 2007 MAX data.
  1. FFS, non-dual disabled enrollees with 10 months of eligibility.
  2. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia.
  3. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is bipolar disorder.
  4. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia or bipolar disorder.
  5. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia and 1 inpatient or 2 outpatient claims where the primary diagnosis is bipolar disorder.

TABLE E.2. Enrollee Demographics
Characteristic Meet All
  Inclusion Critera  
  Schizophreniab   Schizophrenia or
  Bipolar Disorderc  
N N   Percent   N   Percent  
Gender
   Male 425,462 49,949 11.7 58,946 13.9
   Female 593,632 48,462 8.2 71,581 12.1
Age
   25 - 30 96,156 10,454 10.9 14,054 14.6
   31 - 40 170,421 19,770 11.6 27,620 16.2
   41 - 50 298,627 35,211 11.8 46,957 15.7
   51 - 60 351,638 27,890 7.9 35,567 10.1
   61 - 64 102,281 5,087 5.0 6,331 6.2
   Unknown          
Race/Ethnicity
   African American 332,190 38,067 11.5 44,169 13.3
   Caucasian 473,576 41,105 8.7 62,834 13.3
   Hispanic 83,492 7,001 8.4 8,825 10.6
   Other 61,492 5,513 9.0 6,329 10.3
   Unknown 68,373 6,726 9.8 8,372 12.2
Comorbid Diagnoses
   Cardiovascular diseased   84,624 4,700 5.6 6,405 7.6
   Diabetese 178,962 17,027 9.5 21,845 12.2
Managed Care Status
   Enrolled in HMO 126,495 11,273 8.9 16,080 12.7
   Enrolled in BHO 14,352 1,372 9.6 1,900 13.2
   Enrolled in other MC 78,159 6,605 8.5 8,710 11.1
Total 1,019,123   98,412   9.7   130,529   12.8
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. FFS, non-dual, disabled enrollees with 10 months of eligibility.
  2. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia.
  3. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia or bipolar disorder.
  4. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  5. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.3a. Use of Antipsychotic Medication by Enrollee Characteristic
Characteristic   Schizophreniaa   Use of Antipsychotic Medication
N N   Percent  
Gender
   Male 48,642 45,704 94.0
   Female 47,787 44,458 93.0
Age
   25 - 30 10,170 9,639 94.8
   31 - 40 19,312 18,212 94.3
   41 - 50 34,513 32,345 93.7
   51 - 60 27,410 25,326 92.4
   61 - 64 5,025 4,641 92.4
   Unknown 0 0 0.0
Race/Ethnicity
   African American 37,041 34,324 92.7
   Caucasian 40,491 38,003 93.9
   Hispanic 6,898 6,541 94.8
   Other 5,412 5,137 94.9
   Unknown 6,588 6,158 93.5
Comorbid Diagnoses
   Cardiovascular diseaseb   4,683 4,246 90.7
   Diabetesc 16,968 15,942 94.0
Managed Care Status
   Enrolled in HMO 11,018 10,125 91.9
   Enrolled in BHO 1,358 1,287 94.8
   Enrolled in other MC 6,529 6,108 93.6
Total 96,430   90,163   93.5
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia.
  2. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  3. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.3b. Use of Antipsychotic Medication by State
  State     Schizophreniaa   Use of Antipsychotic Medication
N N   Percent  
AL 3,997 3,788 94.8
AK 261 242 92.7
CA 35,895 33,664 93.8
CT 2,672 2,566 96.0
DC 1,588 1,426 89.8
GA 5,997 5,618 93.7
ID 772 714 92.5
IL 12,527 11,570 92.4
IN 3,146 2,985 94.9
IA 1,359 1,288 94.8
LA 4,217 4,004 94.9
MD 4,232 3,973 93.9
MO 4,693 4,442 94.7
MS 3,310 2,959 89.4
NH 368 353 95.9
NC 5,561 5,172 93.0
ND 215 198 92.1
NV 737 702 95.3
OK 2,580 2,359 91.4
SD 249 229 92.0
WV 1,915 1,784 93.2
WY 139 127 91.4
Total   96,430   90,163   93.5
SOURCE: 2007 MAX data.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia.

TABLE E.4a. Antipsychotic Medication Possession Ratio by Enrollee Characteristic
(All States)
Characteristic   Antipsychotic Possession  
Ratio >80%
  Percent  
Gender
   Male 64.9
   Female 63.7
Age
   25 - 30 59.0
   31 - 40 60.8
   41 - 50 62.8
   51 - 60 69.0
   61 - 64 74.2
   Unknown 0.0
Race/Ethnicity
   African American 53.0
   Caucasian 72.6
   Hispanic 64.8
   Other 71.1
   Unknown 69.3
Comorbid Diagnoses
   Cardiovascular diseasea   62.7
   Diabetesb 71.0
Managed Care Status
   Enrolled in HMO 62.1
   Enrolled in BHO 74.7
   Enrolled in other MC 60.5
Total 64.3
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
Antipsychotic Possession Ratio = # Days supplied/# Days in treatment period.
  1. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  2. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.4b. Antipsychotic Medication Possession Ratio by State
  State   Antipsychotic Medication
  Possession Ratio >80%  
  Percent  
AL 59.3
AK 66.5
CA 67.5
CT 72.1
DC 48.3
GA 55.3
ID 78.6
IL 64.2
IN 68.5
IA 74.7
LA 54.7
MD 62.8
MO 66.5
MS 48.9
NH 80.0
NC 64.6
ND 84.6
NV 62.6
OK 62.8
SD 70.9
WV 65.5
WY 65.9
Total   64.3
SOURCE: 2007 MAX data.
Antipsychotic Possession Ratio = # Days supplied/# Days in treatment period.

  TABLE E.5a. Diabetes Screening Among Enrollees with Schizophrenia or Bipolar Disordera by Enrollee Characteristics  
(All States)
Characteristic   Denominator     Diabetes Screen  
N N   Percent  
Gender
   Male 40,443 4,118 10.2
   Female 43,749 4,760 10.9
Age
   25 - 30 10,087 1,096 10.9
   31 - 40 18,686 2,083 11.1
   41 - 50 30,206 3,104 10.3
   51 - 60 21,492 2,199 10.2
   61 - 64 3,721 396 10.6
   Unknown 0 0 0.0
Race/Ethnicity
   African American 27,027 2,469 9.1
   Caucasian 41,324 4,574 11.1
   Hispanic 5,758 728 12.6
   Other 4,463 477 10.7
   Unknown 5,620 630 11.2
Comorbid Diagnoses
   Cardiovascular diseaseb   3,079 384 12.5
   Diabetesc N/A N/A N/A
Managed Care Status
   Enrolled in HMO 10,393 1,191 11.5
   Enrolled in BHO 1,250 255 20.4
   Enrolled in other MC 5,539 695 12.5
Total 84,192   8,878   10.5
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia or bipolar disorder.
  2. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  3. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.5b. Diabetes Screening Among Enrollees with Schizophrenia or Bipolar Disordera by State
  State     Denominator     Diabetes Screen  
N N   Percent  
AL 3,253 420 12.9
AK 245 21 8.6
CA 31,796 3,758 11.8
CT 2,442 689 28.2
DC 1,284 52 4.0
GA 4,683 148 3.2
ID 824 69 8.4
IL 9,515 562 5.9
IN 3,031 543 17.9
IA 1,251 255 20.4
LA 3,499 382 10.9
MD 4,094 93 2.3
MO 5,030 427 8.5
MS 2,392 232 9.7
NH 377 83 22.0
NC 4,735 452 9.5
ND 171 35 20.5
NV 756 67 8.9
OK 2,318 278 12.0
SD 217 53 24.4
WV 2,148 253 11.8
WY 131 6 4.6
Total   84,192   8,878   10.5
SOURCE: 2007 MAX data.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia or bipolar disorder.

  TABLE E.6a. Cardiovascular Health Screening Among Enrollees with Schizophrenia or Bipolar Disordera by Enrollee Characteristics  
Characteristic   Denominator     Cardiovascular Screen  
N N   Percent  
Gender
   Male 45,195 19,384 42.9
   Female 52,338 23,423 44.8
Age
   25 - 30 10,773 3,870 35.9
   31 - 40 20,926 8,507 40.7
   41 - 50 35,219 15,599 44.3
   51 - 60 26,032 12,553 48.2
   61 - 64 4,584 2,279 49.7
   Unknown 0 0 0.0
Race/Ethnicity
   African American 32,001 11,752 36.7
   Caucasian 46,781 21,525 46.0
   Hispanic 7,043 3,657 51.9
   Other 5,256 2,732 52.0
   Unknown 6,453 3,142 48.7
Comorbid Diagnoses
   Cardiovascular diseaseb   N/A N/A N/A
   Diabetesc 16,421 10,173 62.0
Managed Care Status
   Enrolled in HMO 11,715 3,829 32.7
   Enrolled in BHO 1,501 654 43.6
   Enrolled in other MC 6,520 2,937 45.0
Total 97,534   42,808   43.9
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia or bipolar disorder.
  2. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  3. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.6b. Cardiovascular Health Screening Among Enrollees with Schizophrenia or Bipolar Disordera by State
  State     Denominator     Cardiovascular Screen  
N N   Percent  
AL 3,911 1,840 47.0
AK 281 104 37.0
CA 35,706 19,593 54.9
CT 2,985 1,262 42.3
DC 1,488 716 48.1
GA 5,568 547 9.8
ID 994 502 50.5
IL 11,363 2,959 26.0
IN 3,557 1,775 49.9
IA 1,502 654 43.5
LA 3,958 2,002 50.6
MD 4,659 323 6.9
MO 5,770 2,613 45.3
MS 2,880 1,222 42.4
NH 450 285 63.3
NC 5,898 3,313 56.2
ND 210 131 62.4
NV 826 375 45.4
OK 2,651 1,115 42.1
SD 252 118 46.8
WV 2,476 1,311 52.9
WY 149 48 32.2
Total   97,534   42,808   43.9
SOURCE: 2007 MAX data.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia or bipolar disorder.

TABLE E.7a. Diabetes Monitoring Among Enrollees with Schizophreniaa by Enrollee Characteristics
(All States)
Characteristic   Denominator     Diabetes Test  
N N   Percent  
Gender
   Male 6,919 3,557 51.4
   Female 10,107 5,330 52.7
Age
   25 - 30 676 347 51.3
   31 - 40 2,298 1,226 53.4
   41 - 50 6,135 3,195 52.1
   51 - 60 6,509 3,398 52.2
   61 - 64 1,409 722 51.2
   Unknown 0 0 0.0
Race/Ethnicity
   African American 7,125 3,203 45.0
   Caucasian 6,492 3,659 56.4
   Hispanic 1,403 801 57.1
   Other 904 592 65.5
   Unknown 1,103 633 57.4
Comorbid Diagnoses
   Cardiovascular diseaseb   1,755 882 50.3
   Diabetesc 17,027 8,888 52.2
Managed Care Status
   Enrolled in HMO 1,486 638 42.9
   Enrolled in BHO 263 174 66.2
   Enrolled in other MC 1,231 732 59.5
Total 17,027   8,888   52.2
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia.
  2. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  3. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.7b. Diabetes Monitoring Among Enrollees with Schizophreniaa by State
  State     Denominator     Diabetes Test  
N N   Percent  
AL 812 474 58.4
AK 43 11 25.6
CA 5,075 3,376 66.5
CT 566 305 53.9
DC 281 175 62.3
GA 1,118 186 16.6
ID 153 103 67.3
IL 2,958 604 20.4
IN 607 407 67.1
IA 263 174 66.2
LA 651 441 67.7
MD 669 61 9.1
MO 810 460 56.8
MS 640 396 61.9
NH 76 62 81.6
NC 1,294 955 73.8
ND 39 31 79.5
NV 92 68 73.9
OK 432 262 60.6
SD 45 25 55.6
WV 384 301 78.4
WY 19 11 57.9
Total   17,027   8,888   52.2
SOURCE: 2007 MAX data.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia and 1 inpatient or 2 outpatient claims with a primary diagnosis of diabetes.

TABLE E.8a. Cardiovascular Health Monitoring Among Enrollees with Schizophreniaa by Enrollee Characteristics
(All States)
Characteristic   Denominator     Cardiovascular Test  
N N   Percent  
Gender
   Male 2,218 1,250 56.4
   Female 2,482 1,378 55.5
Age
   25 - 30 81 45 55.6
   31 - 40 333 189 56.8
   41 - 50 1,529 852 55.7
   51 - 60 2,185 1,234 56.5
   61 - 64 572 308 53.8
   Unknown 0 0 0.0
Race/Ethnicity
   African American 2,027 999 49.3
   Caucasian 2,028 1,223 60.3
   Hispanic 232 160 69.0
   Other 136 91 66.9
   Unknown 277 155 56.0
Comorbid Diagnoses
   Cardiovascular diseaseb   4,700 2,628 55.9
   Diabetesc 1,755 1,074 61.2
Managed Care Status
   Enrolled in HMO 317 121 38.2
   Enrolled in BHO 49 29 59.2
   Enrolled in other MC 307 180 58.6
Total 4,700   2,628   55.9
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia and 1 inpatient or 2 outpatient claims where the primary diagnosis is cardiovascular disease.
  2. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  3. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.8b. Cardiovascular Health Monitoring Among Enrollees with Schizophreniaa by States
  State     Denominator     Cardiovascular Test  
N N   Percent  
AL 178 99 55.6
AK 12 4 33.3
CA 1,436 1,059 73.7
CT 105 60 57.1
DC 76 36 47.4
GA 260 44 16.9
ID 19 14 73.7
IL 1,147 462 40.3
IN 156 105 67.3
IA 49 29 59.2
LA 222 146 65.8
MD 179 21 11.7
MO 233 136 58.4
MS 107 66 61.7
NH 9 4 44.4
NC 229 158 69.0
ND 5 3 60.0
NV 24 16 66.7
OK 130 82 63.1
SD 7 6 85.7
WV 112 77 68.8
WY 5 1 20.0
Total   4,700   2,628   55.9
SOURCE: 2007 MAX data.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia and 1 inpatient or 2 outpatient claims where the primary diagnosis is cardiovascular disease.

  TABLE E.9a. Cervical Cancer Screening Among Enrollees with Schizophreniaa by Enrollee Characteristics  
(All States)
Characteristic   Denominator     Cervical Cancer Screen  
N N   Percent  
Gender
   Male 0 0 0.0
   Female 47,800 10,913 22.8
Age
   25 - 30 3,347 1,061 31.7
   31 - 40 8,549 2,348 27.5
   41 - 50 17,433 4,194 24.1
   51 - 60 15,313 2,856 18.7
   61 - 64 3,158 454 14.4
   Unknown 0 0 0.0
Race/Ethnicity
   African American 18,419 4,182 22.7
   Caucasian 20,105 4,723 23.5
   Hispanic 3,143 727 23.1
   Other 2,753 552 20.1
   Unknown 3,380 729 21.6
Comorbid Diagnoses
   Cardiovascular diseaseb   2,437 479 19.7
   Diabetesc 9,953 2,429 24.4
Managed Care Status
   Enrolled in HMO 5,753 1,051 18.3
   Enrolled in BHO 757 249 32.9
   Enrolled in other MC 3,619 799 22.1
Total 47,800   10,913   22.8
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Female enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia.
  2. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  3. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.9b. Cervical Cancer Screening Among Enrollees with Schizophreniaa by States
  State     Denominator     Cervical Cancer Screen  
N N   Percent  
AL 2,271 507 22.3
AK 132 28 21.2
CA 16,773 3,623 21.6
CT 1,388 329 23.7
DC 848 210 24.8
GA 3,411 797 23.4
ID 419 120 28.6
IL 5,519 1,223 22.2
IN 1,604 409 25.5
IA 759 250 32.9
LA 2,269 536 23.6
MD 1,987 157 7.9
MO 2,247 666 29.6
MS 1,821 423 23.2
NH 208 60 28.8
NC 3,018 839 27.8
ND 115 40 34.8
NV 387 83 21.4
OK 1,381 299 21.7
SD 131 32 24.4
WV 1,028 264 25.7
WY 84 18 21.4
Total   47,800   10,913   22.8
SOURCE: 2007 MAX data.
  1. Female enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia.

  TABLE E.10a. ED Utilization for Mental Health Conditions Among Enrollees with Schizophreniaa by Enrollee Characteristics  
(All States)
Characteristic   Denominator     ED for Mental Health Conditionsb  
N N   Percent  
Gender
   Male 49,949 13,696 27.4
   Female 48,462 14,805 30.5
Age
   25 - 30 10,454 3,747 35.8
   31 - 40 19,770 6,513 32.9
   41 - 50 35,211 10,279 29.2
   51 - 60 27,890 6,751 24.2
   61 - 64 5,087 1,211 23.8
   Unknown 0 0 0.0
Race/Ethnicity
   African American 38,067 12,145 31.9
   Caucasian 41,105 11,978 29.1
   Hispanic 7,001 1,906 27.2
   Other 5,513 902 16.4
   Unknown 6,726 1,570 23.3
Comorbid Diagnoses
   Cardiovascular diseasec   4,700 2,170 46.2
   Diabetesd 17,027 5,343 31.4
Managed Care Status
   Enrolled in HMO 11,273 2,879 25.5
   Enrolled in BHO 1,372 409 29.8
   Enrolled in other MC 6,605 1,995 30.2
Total 98,412   28,501   29.0
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia.
  2. ED use for mental health conditions includes any ED claim with a visit related ICD-9 code of 290, 293, 295-302, 306-316.
  3. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  4. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.10b. ED Utilization for Mental Health Conditions Among Enrollees with Schizophreniaa by State
  State     Denominator     SMI ED Useb  
N N   Percent  
AL 4,071 1,221 30.0
AK 270 97 35.9
CA 36,571 8,168 22.3
CT 2,699 993 36.8
DC 1,716 564 32.9
GA 6,177 2,003 32.4
ID 781 208 26.6
IL 12,781 4,631 36.2
IN 3,198 830 26.0
IA 1,376 409 29.7
LA 4,314 1,485 34.4
MD 4,340 1,487 34.3
MO 4,775 1,607 33.7
MS 3,377 897 26.6
NH 374 125 33.4
NC 5,670 1,981 34.9
ND 219 53 24.2
NV 749 201 26.8
OK 2,600 785 30.2
SD 279 76 27.2
WV 1,933 630 32.6
WY 142 50 35.2
Total   98,412   28,501   29.0
SOURCE: 2007 MAX data.
  1. Enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia. b. ED utilization for mental health conditions includes any ED claim with a visit related ICD-9 code of 290, 293, 295-302, 306-316.

TABLE E.11a. 7-Day Follow-Up After Mental Health Discharge Among Enrollees with Schizophreniaa by Enrollee Characteristics
(All States)
Characteristic   Denominator     7-Day Follow-Up  
N N   Percent  
Gender
   Male 19,467 4,842 24.9
   Female 19,755 5,731 29.0
Age
   25 - 30 5,064 1,338 26.4
   31 - 40 9,589 2,459 25.6
   41 - 50 14,916 3,998 26.8
   51 - 60 8,414 2,402 28.5
   61 - 64 1,239 376 30.3
   Unknown 0 0 0.0
Race/Ethnicity
   African American 18,259 4,740 26.0
   Caucasian 15,042 4,724 31.4
   Hispanic 2,765 466 16.9
   Other 1,114 208 18.7
   Unknown 2,042 435 21.3
Comorbid Diagnoses
   Cardiovascular diseaseb   4,098 1,161 28.3
   Diabetesc 7,710 2,464 32.0
Managed Care Status
   Enrolled in HMO 4,541 939 20.7
   Enrolled in BHO 725 272 37.5
   Enrolled in other MC 2,337 996 42.6
Total 39,222   10,573   27.0
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Mental health discharges among enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia. Mental health discharges include discharges for any of the following visit related ICD-9 codes: 290, 293, 295-302, 306-316. Follow-up services include any outpatient visit; see Appendix F for a listing of codes included.
  2. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  3. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.11b. 7-Day Follow-Up After Mental Health Discharge Among Enrollees with Schizophreniaa by State
  State     Denominator     7-Day Follow-Up  
N N   Percent  
AL 1,484 650 43.8
AK 32 10 31.3
CA 10,953 908 8.3
CT 1,229 354 28.8
DC 1,303 551 42.3
GA 2,386 843 35.3
ID 72 20 27.8
IL 8,366 2,212 26.4
IN 1,253 656 52.4
IA 725 272 37.5
LA 441 102 23.1
MD 2,864 849 29.6
MO 2,453 832 33.9
MS 1,420 334 23.5
NH 121 80 66.1
NC 2,181 1,123 51.5
ND 79 20 25.3
NV 124 47 37.9
OK 862 349 40.5
SD 106 35 33.0
WV 735 309 42.0
WY 33 17 51.5
Total   39,222   10,573   27.0
SOURCE: 2007 MAX data.
  1. Mental health discharges among enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia. Mental health discharges include discharges for any of the following visit related ICD-9 codes: 290, 293, 295-302, 306-316. Follow-up services include any outpatient visit; see Appendix F for a listing of codes included.

TABLE E.12a. 30-Day Follow-Up After Mental Health Discharge Among Enrollees with Schizophreniaa by Enrollee Characteristics
(All States)
Characteristic   Denominator     30-Day Follow-Up  
N N   Percent  
Gender
   Male 14,622 7,340 50.2
   Female 15,930 9,277 58.2
Age
   25 - 30 3,949 2,047 51.8
   31 - 40 7,284 3,771 51.8
   41 - 50 11,470 6,213 54.2
   51 - 60 6,795 3,948 58.1
   61 - 64 1,054 638 60.5
   Unknown 0 0 0.0
Race/Ethnicity
   African American 13,734 7,230 52.6
   Caucasian 12,114 7,371 60.8
   Hispanic 2,135 883 41.4
   Other 924 387 41.9
   Unknown 1,645 746 45.3
Comorbid Diagnoses
   Cardiovascular diseaseb   2,804 1,728 61.6
   Diabetesc 5,852 3,807 65.1
Managed Care Status
   Enrolled in HMO 3,582 1,634 45.6
   Enrolled in BHO 597 470 78.7
   Enrolled in other MC 2,033 1,472 72.4
Total 30,552   16,617   54.4
SOURCE: 2007 MAX data.
HMO = health maintenance organization; BHO = behavioral healthcare organization; MC = managed care.
  1. Mental health discharges among enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia. Mental health discharges include discharges for any of the following visit related ICD-9 codes: 290, 293, 295-302, 306-316. Follow-up services include any outpatient visit; see Appendix F for a listing of codes included.
  2. Refer to Appendix F for all CPT, HCPC, and ICD9 codes used to identify cardiovascular disease.
  3. Diabetes identified using ICD-9 diagnoses of 250, 357.2, 362.0, 366.41, 648.0.

TABLE E.12b. 30-Day Follow-Up After Mental Health Discharge Among Enrollees with Schizophreniaa by State
  State     Denominator     30-Day Follow-Up  
N N   Percent  
AL 1,329 950 71.5
AK 27 21 77.8
CA 8,498 2,172 25.6
CT 1,008 602 59.7
DC 941 613 65.1
GA 2,008 1,349 67.2
ID 66 48 72.7
IL 5,601 3,119 55.7
IN 1,091 897 82.2
IA 597 470 78.7
LA 412 247 60.0
MD 2,195 1,348 61.4
MO 1,938 1,226 63.3
MS 1,257 770 61.3
NH 96 85 88.5
NC 1,881 1,471 78.2
ND 69 55 79.7
NV 107 81 75.7
OK 713 530 74.3
SD 83 57 68.7
WV 605 480 79.3
WY 30 26 86.7
Total   30,552   16,617   54.4
SOURCE: 2007 MAX data.
  1. Mental health discharges among enrollees with 1 inpatient or 2 outpatient claims where the primary diagnosis is schizophrenia. Mental health discharges include discharges for any of the following visit related ICD-9 codes: 290, 293, 295-302, 306-316. Follow-up services include any outpatient visit; see Appendix F for a listing of codes included.

TABLE E.13. Distributions of Measures at the State Level
(N=22)
Measure   Minimum   25th
  Percentile  
  Median     Mean   75th
  Percentile  
  Maximum  
Schizophrenia
   Use of Antipsychotic Medications 89.4 92.1 93.4 93.3 94.8 96.0
   Antipsychotic Medication Possession Ratio 48.3 62.6 65.7 65.7 70.9 84.6
   Diabetes Monitoring 9.1 55.6 62.1 57.3 67.7 81.6
   Cardiovascular Health Monitoring 11.7 44.4 59.6 54.5 67.3 85.7
   Cervical Cancer Screening 7.9 21.7 23.7 24.4 27.8 34.8
   ED Utilization For Mental Health Conditions 22.3 26.8 32.5 31.0 34.4 36.8
   Follow-up After Mental Health Discharge (7-day) 8.3 27.8 34.6 36.0 42.3 66.1
   Follow-up After Mental Health Discharge (30-day)   25.6 61.4 72.1 69.7 78.7 88.5
Schizophrenia or Bipolar Disorder
   Diabetes Screening 2.3 8.4 10.3 12.1 17.9 28.2
   Cardiovascular Health Screening 6.9 42.1 46.1 43.4 50.6 63.3
SOURCE: 2007 MAX data.

TABLE E.14. Utilization by Measure Performance Quartile
Measure Enrollees Hospitalized for Schzophrenia (Percentage) Enrollees Hospitalized for Schzophrenia (Percentage)
States in
  Bottom 25%  
  States in  
Top 25%
States in
  Bottom 25%  
  States in  
Top 25%
Schizophrenia
   Use of antipsychotic medications 18.5 10.5 21.2 22.3
   Antipsychotic possession ratio 14.0 15.5 23.4 23.3
   Diabetes monitoring 23.7 14.3 26.7 24.2
   Cardiovascular health monitoring 24.2 17.1 26.6 16.1
   Cervical cancer screen 17.9 18.4 15.8 21.2
   Mental health follow-up (7 day) 19.4 16.3 18.1 23.0
   Mental health follow-up (30 day)   19.3 16.0 18.6 19.1
Schizophrenia or Bipolar Disorder
   Diabetes screening 24.3 18.1 26.6 24.5
   Cardiovascular health screening 24.2 17.4 26.6 16.2
SOURCE: 2007 MAX data.
NOTES:
Lower rates of hospitalization and ED use hypothesized for enrollees in the top 25% for each measure.
Hospitalization percentages significantly different at p<0.01 except Cervical Cancer Screen.
ED percentages significantly different at p<0.01 except Use of Antipsychotic Medications, Antipsychotic Possession Ratio, and Mental Health Follow-up (30-day).

TABLE E.15. Enrollee Level Correlation Matrix
(2007)
    Antipsychotic  
Use
  Antipsychotic  
Possession
Ratio
Diabetes
  Screening  
Diabetes
  Monitoring  
  Cardiovascular  
Screening
  Cardiovascular  
Monitoring
  Cervical  
Cancer
Screen
ED
  Utilization  
(MH)
  Follow-Up  
(7-Day)
Antipsychotic Use                  
Antipsychotic Possession Ratio   0.000                
Diabetes Screening 0.000 0.063              
Diabetes Monitoring 0.013 0.073 0.000            
Cardiovascular Screening 0.000 0.116 0.276 0.908          
Cardiovascular Monitoring 0.039 0.073 0.198 0.888 0.000        
Cervical Cancer Screen -0.008 0.028 0.050 0.082 0.112 0.104      
ED Utilization (MH) 0.031 -0.138 0.013 -0.038 -0.026 -0.033 -0.013    
MH Follow-up (7-day) 0.092 0.103 0.014 0.081 0.068 0.095 0.051 0.060  
MH Follow-up (30-day) 0.105 0.153 0.007 0.092 0.063 0.069 0.081 0.019 0.495
SOURCE: 2007 MAX data.

TABLE E.16. State Measure Correlations, 2007-2008
(N=16)
    2007-2008 Correlation  
Use of Antipsychotic Medications 0.252
Antipsychotic Medication Possession Ratio 0.550
Diabetes Screening 0.330
Diabetes Monitoring 0.453
Cardiovascular Health Screening 0.426
Cardiovascular Health Monitoring 0.403
Cervical Cancer Screen 0.314
ED Utilization for Mental Health Conditions 0.416
Follow-up after Mental Health Discharge (7-day) 0.173
Follow-up: after Mental Health Discharge (30-day)   0.202
SOURCE: 2007 and 2008 MAX data.

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