Brenda Natzke

Temporal trends in anti-diabetes drug use in tricare following safety warnings in 2007 about rosiglitazone†

To describe utilization patterns for anti‐diabetes medications among a cohort of diabetes patients in the Military Health System (MHS) before and after warnings about rosiglitazone issued in May 2007.

State Variation in Out-of-Home Medicaid Mental Health Services for Children and Youth: An Examination of Residential Treatment and Inpatient Hospital Services

This research investigated state variation in the use of out-of-home mental health services among children and youth enrolled in Medicaid during 2003. Medicaid claims from three states were used to describe the demographic and diagnostic characteristics of children and youth under age 22 who received mental health services in general hospitals, psychiatric hospitals, psychiatric residential treatment facilities, and other residential treatment settings and to examine their lengths of stay, repeat stays, and expenditures. Depending on the state, 6–13% of children and youth with a mental health diagnosis received out-of-home services during the year; 37–58% of these children and youth had more than one out-of-home stay. Out-of-home mental health services accounted for 21–75% of Medicaid mental health expenditures for children and youth, depending on the state. States varied considerably in lengths of stay and per beneficiary expenditures for out-of-home care. Although some similarities in out-of-home care were found across states, substantial state variation in out-of-home care warrants further research in the context of state service systems and Medicaid policies.

Associations between practice-reported medical homeness and health care utilization among publicly insured children.

BACKGROUND The patient-centered medical home (PCMH) is widely promoted as a model to improve the quality of primary care and lead to more efficient use of health care services. Few studies have examined the relationship between PCMH implementation at the practice level and health care utilization by children. Existing studies show mixed results. METHODS Using practice-reported PCMH assessments and Medicaid claims from child-serving practices in 3 states participating in the Childrens Health Insurance Program Reauthorization Act of 2009 Quality Demonstration Grant Program, this study estimates the association between medical homeness (tertiles) and receipt of well-child care and nonurgent, preventable, or avoidable emergency department (ED) use. Multilevel logistic regression models are estimated on data from 32 practices in Illinois (IL) completing the National Committee for Quality Assurances (NCQA) medical home self-assessment and 32 practices in North Carolina (NC) and South Carolina (SC) completing the Medical Home Index (MHI) or Medical Home Index-Revised Short Form (MHI-RSF). RESULTS Medical homeness was not associated with receipt of age-appropriate well-child visits in either sample. Associations between nonurgent, preventable, or avoidable ED visits and medical homeness varied. No association was seen among practices in NC and SC that completed the MHI/MHI-RSF. Children in practices in IL with the highest tertile NCQA self-assessment scores were less likely to have a nonurgent, preventable, or avoidable ED visit than children in practices with low (odds ratio 0.65; 95% confidence interval 0.47-0.92; P < .05) and marginally less likely to have such a visit compared with children in practices with medium tertile scores (odds ratio 0.72, 95% confidence interval 0.52-1.01; P = .06). CONCLUSIONS Higher levels of medical homeness may be associated with lower nonurgent, preventable, or avoidable ED use by publicly insured children. Robust longitudinal studies using multiple measures of medical homeness are needed to confirm this observation.

Early Experiences Engaging Patients Through Patient and Family Advisory Councils.

Primary care practices are increasingly asked to engage patients in improving care delivery. We report early experiences with Patient and Family Advisory Councils (PFACs) from interviews of patients and practice staff in the Comprehensive Primary Care initiative, and identify ways to improve PFACs. Patients and practice staff report PFACs help practices elicit patient feedback and, in response, improve care delivery. Nonetheless, there are areas for refinement, including recruiting more diverse patients, providing an orientation to members, overcoming reticence of some patients to raise issues, and increasing transparency by sharing progress with PFAC members and patients in the practice more generally.

Implementing a Whole Health Model in a Community Mental Health Center: Impact on Service Utilization and Expenditures

OBJECTIVE This study examined whether implementing a whole health care model in a community mental health center reduced the use of acute care services and total Medicare expenditures. The whole health care model embedded monitoring of overall health and wellness education within the centers outpatient mental and substance use disorder treatment services, and it improved care coordination with primary care providers. METHODS This study used fee-for-service Medicare administrative claims and enrollment data for June 2009 through July 2015 for the intervention (N=846) and matched comparison group (N=2,643) to estimate a difference-in-differences model. RESULTS For the first two-and-a-half years of the program, Medicare expenditures decreased by

CHIPRA Mandated Evaluation of Express Lane Eligibility: Final Findings

266 per month on average for each enrolled beneficiary in the intervention group relative to the comparison group (p<.01). Intervention clients had .02 fewer hospitalizations, .03 fewer emergency department (ED) visits, and .13 fewer office visits per month relative to the comparison group (p<.05 for all estimates). CONCLUSIONS Overall, the whole health model reduced Medicare expenditures, ED visits, and hospitalization rates. These results may be due in part to the availability of more comprehensive medical data and staffs improved awareness of clients overall health needs. There was a lag between initial program implementation and the programs substantial impact on health expenditures. This lag may be attributed to the substantial transformation and time needed for staff to adapt to the program.