Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599-7411. Email:
Am J Manag Care. 2020 May;26(5):218-223. doi: 10.37765/ajmc.2020.43153.
To assess the effect of medical home enrollment on acute care use and healthcare spending among Medicaid beneficiaries with mental and physical illness.
Retrospective cohort analysis of administrative data.
We used 2007-2010 Medicaid claims and state psychiatric hospital data from a sample of 83,819 individuals diagnosed with schizophrenia or depression and at least 1 comorbid physical condition. We performed fixed-effects regression analysis at the person-month level to examine the effect of medical home enrollment on the probabilities of emergency department (ED) use, inpatient admission, and outpatient care use and on amount of Medicaid spending.
Medical home enrollment had no effect on ED use in either cohort and was associated with a lower probability of inpatient admission in the depression cohort (P <.05). Medical home enrollees in both cohorts experienced an increase in the probability of having any outpatient visits (P <.05). Medical home enrollment was associated with an increase in mean monthly spending among those with schizophrenia ($65.8; P <.05) and a decrease among those with depression (-$66.4; P <.05).
Among Medicaid beneficiaries with comorbid mental and physical illness, medical home enrollment appears to increase outpatient healthcare use and has mixed effects on acute care use. For individuals in this population who previously had no engagement with the healthcare system, use of the medical home model may represent an investment in providing improved access to needed outpatient services with cost savings potential for beneficiaries with depression.
评估医疗之家的参与对同时患有精神和身体疾病的医疗补助受益人急性护理使用和医疗保健支出的影响。
对行政数据进行回顾性队列分析。
我们使用了来自一个样本的 83819 名被诊断患有精神分裂症或抑郁症的个人和至少 1 种合并躯体疾病的 2007-2010 年医疗补助索赔和州立精神病院数据。我们在人月水平上进行固定效应回归分析，以检查医疗之家的参与对急诊（ED）使用、住院入院和门诊护理使用的概率以及医疗补助支出金额的影响。
医疗之家的参与对两个队列中的 ED 使用均无影响，且与抑郁队列中住院入院的可能性降低相关（P<.05）。两个队列中的医疗之家参与者门诊就诊的可能性增加（P<.05）。医疗之家的参与与精神分裂症患者的平均每月支出增加（65.8 美元；P<.05）以及抑郁症患者的支出减少（-66.4 美元；P<.05）有关。
在患有合并精神和躯体疾病的医疗补助受益人中，医疗之家的参与似乎增加了门诊医疗保健的使用，并对急性护理的使用产生了混合影响。对于那些以前没有参与医疗保健系统的该人群中的个体来说，使用医疗之家模式可能代表着为改善对所需门诊服务的获得提供投资，同时具有节省患有抑郁症的受益人的成本的潜力。
