Structuring the Integration of Care Management Services For Medicaid Enrollees Recipients With Chronic Illness, Substance Abuse Problems and Possible Psychiatric Disorders

Chronic Illness Clinical Trial

Official title:

Structuring the Integration of Services For Medicaid Recipients With Chronic Illness, Substance Abuse Problems and Possible Psychiatric Disorders

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT00399373
• Other study ID #: NA_00001352
• Secondary ID: 100326 (CHCS)
• Status: Terminated
• Phase: N/A
• First received: November 13, 2006
• Last updated: December 5, 2017
• Start date: November 2005
• Est. completion date: October 2008

Study information

• Verified date: December 2017
• Source: Johns Hopkins University
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The study seeks to measure the effect of increased coordination of care on medical costs, treatment utilization and selected clinical indicators among a Medicaid population with chronic medical conditions and substance abuse problems? We shall address this question by conducting a demonstration project consisting of the provision of integrated care management (somatic and behavioral) to Medicaid enrollees living on the Eastern Shore of Maryland and who have both chronic medical conditions and problems with substance abuse. A specific component of the study will be the participation of Maryland's Mental Health Administration (MHA) and MAPS, the administrator of psychiatric services for the Medicaid enrollees in Maryland. We shall compare the results of the integrated care management for the study sample on the Eastern Shore with a control group from the counties of western Maryland.

Description:

Problem in context. In an environment of increased competition for governmental funding, Medicaid programs in every state are bracing for decreased resources being available for the care of their enrollees. A possible result of less funding is reduced quality of healthcare. In response to this threat, The Center for Health Care Strategies, Inc, (CHCS) a non-profit organization dedicated to improving the quality of publicly financed health care, issued an RFP for participation in a multisite project to expand or enhance existing efforts to improve the way care for Medicaid enrollees with multiple chronic conditions is delivered, integrated, measured and financed.

Present knowledge. While there is strong documentation of improved population health status with care management, the evidence for the immediate economic effects of care management initiatives is mixed for commercial and absent for Medicaid populations. CHCS is presently conducting a multisite study (in which we participate) of whether or not a business case (return on investment) can be made for quality improvement initiatives in a Medicaid population.

Research question. What is the effect of increased coordination of care on medical costs, treatment utilization and selected clinical indicators among a Medicaid population with chronic medical conditions and substance abuse problems? We shall address this question by conducting a demonstration project consisting of the provision of integrated care management (somatic and behavioral) to Medicaid enrollees living on the Eastern Shore of Maryland and who have both chronic medical conditions and problems with substance abuse. A specific component of the study will be the participation of Maryland's Mental Health Administration (MHA) and MAPS, the administrator of psychiatric services for the Medicaid enrollees in Maryland. We shall compare the results of the integrated care management for the study sample on the Eastern Shore with a control group from the counties of western Maryland.

The primary goal of the project will be to improve the coordination of medical, substance abuse and mental health services for a group of Medicaid beneficiaries with chronic medical conditions. We hypothesize that the recipients of integrated care management (on the Eastern Shore) will have lower total medical costs (pharmacy, inpatient and outpatient), higher utilization of mental health and substance abuse services and lower use of emergency department services than those who received customary care (in western Maryland).

The secondary goal of this project will be to assist in the further development and piloting of information systems within MHA that will facilitate sharing of clinical information necessary for the coordination of behavioral (mental health and substance abuse) and medical care management between a Medicaid MCO (JHHC's PPMCO) and the mental health carve-out ASO, MAPS-MD. The outcome measurement for the secondary objective will be the extent to which an information system for coordination of care and population based queries has been established within MHA and is, with proper oversight by MHA, accessible to responsible entities.

Significance. The project targets a vulnerable population within Medicaid enrollees that are challenged when accessing care and are responsible for high total medical costs. The results of the project should be helpful to other the MCOs in Maryland's Health Partners, as well as to states with similar Medicaid systems as they seek to provide integrated healthcare services to their populations.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 258
• Est. completion date: October 2008
• Est. primary completion date: October 2008
• Accepts healthy volunteers: No
• Gender: All
• Age group: 21 Years to 65 Years

Eligibility

Inclusion Criteria:

1. 21 years of age or older;

2. Resident of one of the following Maryland counties: Caroline, Cecil, Kent, Queen Anne's, Talbot, Dorchester, Somerset, Wicomico, Worcester, Allegheny, Frederick, Garrett, Washington, Calvert, Charles, or St. Mary's; or

3. Chronic medical condition(s) identified by ACG Case Mix software (e.g. an ACG score => 0.10) as likely to incur high costs in the following year; and

4. Substance use problem in the past 27 months as indicated by an ICD-9 code or CPT code on DHMH list for Special Needs Population.

Exclusion Criterion.

1) Enrolled in or eligible for enrollment in a Special Needs disease management program at JHHC: HIV/AIDS, Partners with Mom, Omega Life. It is necessary to exclude these programs because PPMCO members are already receiving intensive care management.

Related Conditions & MeSH terms

• Chronic Disease
• Chronic Illness
• Mental Disorders
• Problem Behavior
• Substance-Related Disorders

Locations

Country	Name	City	State
United States	Johns Hopkins HealthCare LLC	Glen Burnie	Maryland

Sponsors (1)

Lead Sponsor	Collaborator
Johns Hopkins University

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Total medical costs (per member per month)		monthly average, calculated at the end of 12 months