Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder. D. State Variation in Receipt of Multiple EBPs

04/09/2012

We found variation between states in the proportion of beneficiaries who received a combination of continuous medications, psychosocial services, and medication monitoring (Figure 7). Nearly twice as many beneficiaries with schizophrenia and bipolar disorder had high medication continuity in the best-performing state, compared to the worst-performing state (72 percent versus 35 percent). Similarly, the proportion of beneficiaries with high medication continuity and at least one claim for a psychosocial service varied from 24 percent to 55 percent among states. However, the proportion of beneficiaries who had high medication continuity, at least one psychosocial claims, and medication monitoring or screening for cardiovascular disease or diabetes was uniformly low for all states: depending on the state, only between 1 percent and 15 percent of beneficiaries received all of these services (Table 8).

FIGURE 7. Proportion of Medicaid Beneficiaries in Each State Receiving Multiple EBPs

Figure 7 is a scatter plot where the dots are arranged in four sets of vertical lines. Each dot represents the proportion of beneficiaries in each state who received one, two, three, or all four evidence-based treatments. The dispersion of the dots vertically in each set represents the amount of variation between the 22 states in the study on the proportion of beneficiaries receiving the multiple EBPs. The first set is the proportion of beneficiaries who received an evidence-based medication. States ranged from 83 to 94 percent. The second set is the proportion that received evidence-based medication and also had high medication continuity. States ranged from 35 to 72 percent, although most states were between 47 and 65 percent. The third set is the proportion that received appropriate medication, had high medication continuity, and also received at least one psychosocial service. States ranged from 24 to 55 percent, with most states between 39 and 47 percent. The fourth set is the proportion that received an appropriate medication, had high medication continuity, received a psychosocial service, and also received all recommended blood tests to check medication levels, cholesterol, and glucose levels. States ranged from 1 to 14 percent, with most states below 9 percent.

SOURCE: MAX data, calendar year 2007.

NOTES: Each diamond in the figure represents the proportion of beneficiaries in a state who received the service.


TABLE 8. Proportion of Beneficiaries in Each State Receiving Multiple EBPs

  State  

Received an Appropriate Medication

…and had High Medication Continuity

…and Received at Least One Psychosocial Service

…and Received Medication Level Monitoringa

…and Received Health Screening for Medication Side Effectsb

Median   89.9 55.2 41.4 39.2 5.3

SOURCE: MAX data, calendar year 2007.

NOTES: Data on medication monitoring and health screenings is not displayed for Maryland, as very low rates of medication monitoring and health screenings may be a result of missing laboratory encounter data for HMO enrollees.

  1. Among bipolar beneficiaries using lithium, valproate, and carbamazepine. Beneficiaries not using any of these drugs were counted as receiving the EBP.
  2. Among users of antipsychotics. Beneficiaries not using an antipsychotic were counted as receiving the EBP.
AK 88.1 57.4 44.6 41.1 3.7
AL 91.9 51.9 46.5 44.8 7.7
CA 90.8 57.3 47.2 45.3 6.2
CT 93.5 63.3 31.5 30.5 6.0
DC 82.9 35.4 32.6 31.0 1.4
GA 90.0 46.7 39.2 38.0 0.9
IA 91.1 65.1 40.9 39.2 8.6
ID 89.0 61.1 55.1 52.1 5.8
IL 89.8 54.2 39.8 37.0 2.0
IN 90.9 56.3 45.0 42.9 8.3
LA 92.5 48.7 28.0 27.1 4.5
MD 89.2 49.8 41.9 n.r. n.r.
MO 90.8 54.6 39.1 35.9 4.7
MS 86.0 39.5 27.7 27.1 3.0
NC 89.6 53.0 42.3 40.8 5.3
ND 89.3 71.8 31.6 30.6 8.6
NH 91.3 64.7 54.6 53.5 12.4
NV 93.0 56.1 45.7 43.0 5.7
OK 88.1 50.6 38.7 36.6 4.8
SD 82.0 55.9 45.6 44.1 13.5
WV 88.1 48.9 24.4 22.6 4.2
WY 89.9 58.6 49.8 46.7 2.2

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