Medicaid Managed Care - U.S. Senate Special Committee on Aging

Mental Health
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* HMOs reported fewer numbers of persons who received at least one mental health visit (3%)
than did fee-for-service (5%). However, of those persons who did receive at Leas one mental
health visit, the numberof serices received in 1995 was similar between HMOs (53) andfeefor-service
(5.8). Mentalillness affectsa largenumberofpeople, especiaLyadolescents andadults-
Differences between fee-for-sevi e and HIOs rdadtno todg, priorumetnformlhealsh
services mand diffeent styles of service delivery mayacoantffrhigb missofnepetdencxounters
in fec-for-service. For example mental illnessesachd as depression- am often neat by prnary cae
physicians. Mental health scxeningvisitsaenocreportedhe. Based onthesedata, Etfle can be said
about qualiy and outcomes forrpersons wiffi m lnesses. Assgftl<strong>Medicaid</strong>redpiatshave
access to quality menial health serves is importanL Forthis reason. several rtiviteslraed tomental
health have been initiated by the stae: <strong>Medicaid</strong> studies involvingadtsimnd chart reviews have been
conducted, a"Mental Health/AODA Wocrowp" was recently reconved, and special program to
trainpmnrycareproviders toaggressively scxenforcomnuonmen
begin in 1997.
sassandubsta abusevwM
Percent of recipients who had at least one Aveage number of visits among dnes reonlg one
mental heafth/AODA visit in 1995 or mor mentl hAOtAbervin 1995
EIRP
Chronic Conditions
* In children and adolescents, the diagnosis of asthma is more common among HMO enrollees
(4%o) than in fee-for-service (2%*), with Milwaukee HMO recipients reporting th highest rate
of asthma diagnoses (5%). However, the rate of hospiiaonsfor asth wasfour dimes as
high among children and adoleseent in managedcare (0.4%o vens 0.1%). Asthma is a chronic
and soretines life-tuatening sase. It is the mstormon chronic discase inyoung people. African
Americans and people who live in cities are affected mote often than others. M-fany asthmnahospitalizations
may be avoidabic. Without having other information, such as severity forexample, conclusions
about quality of care are not possible. Since 1995. several HMOs have initiated asthma outreach and
intervention programs.
Percent of recipients with a diagnosis of Percent of reaplents hospitafid for asthma
asthma in 1995 in 1995