Performance Improvement 2013-2014. Do Patients with Schizophrenia and Bipolar Disorder Receive Treatments Considered Evidence-Based Practices?

01/01/2014

As the single largest payer of mental health services, Medicaid can promote the delivery of evidence-based practices (EBPs) for individuals with serious and persistent mental illness (SPMI). This study demonstrated the feasibility of using Medicaid claims and encounter data to assess whether patients were receiving EBP's in 2007, and to identify populations to target for quality improvement. This study used Medicaid data from 22 states to examine the extent to which Medicaid beneficiaries with schizophrenia and bipolar disorder received evidence-based medications, psychosocial services, and physical health care.

Although the vast majority of beneficiaries filled at least one prescription for an evidence-based medication, states varied widely in the proportion that maintained a continuous supply of medications and received recommended monitoring of medication levels. Beneficiaries living in states that required copayments or prior authorization for medications were less likely to fill prescriptions regularly. Across all study states, three-quarters of beneficiaries received at least one psychosocial service during the year, but it was difficult to discern from claims whether these services were evidence-based. Only 45 percent of beneficiaries with schizophrenia and 35 percent with bipolar disorder maintained a continuous supply of evidence-based medications and received at least one psychosocial service during the year. The findings suggest that there is much room for improvement in the delivery of evidence-based care for this costly and vulnerable population.

Report Title: Evidence-Based Treatment for Schizophrenia and Bipolar Disorder in State Medicaid Programs: Issue Brief, http://aspe.hhs.gov/daltcp/reports/2012/sbpdIB.shtml
Report Title: Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder, http://aspe.hhs.gov/daltcp/reports/2012/ebpsbd.shtml

Agency Sponsor: OASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: John Drabek, 202-690-6443
Performer: Mathematica Policy Research
Record ID: 10053 &10052 (February 1 and April 9, 2012)

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