Dr. Frimpong, Ms. Wang, and Dr. Radigan are with the New York State Office of Mental Health, Albany. Ms. Kuang is with the New York State Department of Health, Albany.
Psychiatr Serv. 2018 Nov 1;69(11):1160-1166. doi: 10.1176/appi.ps.201700537. Epub 2018 Aug 28.
The study compared Medicaid cost-effectiveness for children with serious emotional disturbance receiving services from two programs operated by the New York State Office of Mental Health: the Home and Community-Based Services (HCBS) Waiver program and targeted case management (TCM).
Children ages four to 18 who received services from the HCBS Waiver program (N=1,602) or TCM (N=2,740) during 2009-2012 were selected. A quasi-experimental study design with propensity score-matched comparison groups was used to examine Medicaid costs (per member per month [PMPM] total cost) before admission to and after discharge from the HCBS Waiver and TCM programs. Exponential smoothing models were used to examine Medicaid cost trends before and after each program. Difference-in-difference techniques were used to estimate the average annual difference in PMPM Medicaid cost.
Trends for PMPM total Medicaid cost for HCBS Waiver-enrolled children after discharge decreased by 25%, whereas postdischarge costs for TCM-enrolled children increased by 15%. The adjusted pre-to-post difference in PMPM total Medicaid cost for HCBS Waiver children decreased by $498 and increased for TCM children by $448-a statistically significant decline of $946 (range $927-$963) in average PMPM Medicaid cost for HCBS Waiver children compared with TCM children.
The PMPM Medicaid cost for children during HCBS Waiver enrollment was higher than for similar children enrolled in TCM. However, Medicaid cost savings for the HCBS Waiver group after the program may support investment in the more intensive HCBS Waiver program for children with comparable psychiatric needs.
本研究比较了纽约州心理健康办公室运营的两项计划（家庭和社区为基础的服务豁免计划和有针对性的病例管理）为患有严重情绪障碍的儿童提供服务的医疗补助成本效益。
在 2009-2012 年期间，选择了接受家庭和社区为基础的服务豁免计划（N=1602）或有针对性的病例管理（N=2740）的 4 至 18 岁的儿童。采用倾向评分匹配比较组的准实验研究设计，以检查 HCBS 豁免计划和 TCM 计划入院前和出院后的医疗补助费用（每名成员每月总费用 [PMPM]）。使用指数平滑模型检查每个计划前后的医疗补助费用趋势。使用差异中的差异技术来估计 PMPM 医疗补助成本的年平均差异。
HCBS 豁免计划中出院后儿童的 PMPM 总医疗补助费用趋势下降了 25%，而 TCM 计划中出院后儿童的 PMPM 总医疗补助费用则增加了 15%。HCBS 豁免计划儿童的 PMPM 总医疗补助费用调整前后差异减少了 498 美元，而 TCM 儿童的 PMPM 总医疗补助费用增加了 448 美元，这意味着 HCBS 豁免计划儿童的 PMPM 医疗补助成本比 TCM 儿童平均减少了 946 美元（范围为 927-963 美元）。
在 HCBS 豁免计划中，儿童的 PMPM 医疗补助费用高于类似情况下参加 TCM 计划的儿童。然而，HCBS 豁免计划组在计划结束后的医疗补助成本节省可能支持为具有类似精神需求的儿童投资更密集的 HCBS 豁免计划。
