Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder. B. Preventive Physical Health Services

04/09/2012

Like other adults enrolled in Medicaid, beneficiaries with schizophrenia and bipolar disorder should receive basic preventive health services, such as periodic comprehensive exams or certain cancer screenings recommended for all adults of a certain age. Preventive health services are particularly important for this population in light of evidence that individuals with schizophrenia and bipolar disorder die 1-2 decades earlier than the general population (Laursen 2011). Premature death among this population is related to their increased prevalence of cardiovascular disease and diabetes (Hennekens et al. 2005) brought on by illness-related or genetic risk factors (Fleischhacker et al. 2008), obesity (Fontaine et al. 2001), smoking or other unhealthy behaviors (Tran et al. 2009), and side effects of certain antipsychotic medications (Newcomer 2005). Some studies have found that, compared with the general population, individuals with schizophrenia have twice the risk of developing metabolic syndrome, which increases their risk for future cardiovascular disease and diabetes (Cohn et al. 2004). There is also some evidence from smaller studies that older women with schizophrenia are less likely than those without schizophrenia to receive mammograms in the past 2 years (68 percent versus 98 percent) or a pelvic examination and Pap test in the past 3 years (71 percent versus 96 percent) (Lindamer et al. 2003).

We examined the extent to which Medicaid beneficiaries with schizophrenia or bipolar disorder received preventive health services during 2007. These included either a comprehensive physical examination or health behavior counseling (for example, smoking cessation or weight counseling). Only those procedure codes that clearly identified these services were used for the analysis. Thus, it is possible that our measure of preventive health services did not capture services that were delivered during medical visits for acute or chronic conditions but not billed separately as preventive health services.

We constructed measures to examine whether beneficiaries received cancer screening, which included colorectal cancer screening (colonoscopy) for men and women, and cervical (Pap smear) or breast (mammogram) cancer screening for women. These screenings were included in the measure of preventive health services rather than reported separately. Because the study used only 1 year of data, it was not possible to measure whether beneficiaries received guideline-concordant cancer screening (for example, screening that is to take place every few years).

When data was combined from all states, only 11 percent of beneficiaries with schizophrenia or bipolar disorder had a claim for a comprehensive physical examination or health behavior counseling in 2007. Some research suggests that Medicaid beneficiaries are about as likely as those with private insurance to receive a preventive physical health examination, with slightly less than one-quarter of adults in each group receiving an examination (Mehrotra, Zaslavsky, Ayanian 2007). Although the findings from this study are not directly comparable to Mehrotra et al. (2007) due to methodological differences in the way physical health examinations were measured, these findings may provide some preliminary evidence that disabled Medicaid beneficiaries with schizophrenia and bipolar disorder receive a physical examination less often than the overall Medicaid population,5 but further research is needed to examine differences between the population included in this study and other populations. Only 8 percent of men ages 50-64 with schizophrenia or bipolar disorder received a colonoscopy during 2007. Women were more likely to receive a cancer screening: 26 percent of all women with schizophrenia or bipolar disorder received screening for cervical cancer during 2007, and 15 percent between the ages of 41 and 64 received a mammogram. Eleven percent of women ages 50-64 received a colonoscopy in that year. When the definition of preventive health service was expanded to include recommended cancer screenings, 30 percent of beneficiaries received a cancer screening or comprehensive physical health examinations in 2007.

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