Impact of a managed controlled-opioid prescription monitoring program on care coordination.

Introduction: Inappropriate opioid medication utilization has grown tremendously in recent years. Managed care organizations have the opportunity to identify potential opioid misuse and implement care coordination interventions.

Methods: This randomized controlled study evaluated the impact of providing actionable information to prescribers of members who received opioid prescriptions from 3 or more prescribers at 3 or more pharmacies in a 3-month identification period.

Impact of point-of-care case management on readmissions and costs.

Objective: To measure the impact of point-of-care case management by a team of diverse clinical specialists at a large medical group on 30-day readmissions and associated costs.

Study Design: An intent-to-treat, historical, baseline cohort comparison design.

Methods: A case management team employed by a managed care organization was integrated into the point of care at 4 medical offices of a medical group to provide services to health plan members who were medically hospitalized.

Reducing six-month inpatient psychiatric recidivism and costs through case management.

The objective of this study is to determine the reduction in inpatient psychiatric recidivism and costs associated with an intensive case management (ICM) program among high-risk adults with chronic mental health conditions. An intent-to-treat, historical control design was used to examine utilization differences between 306 intervention group (IG) members eligible to receive ICM services and a cohort of 290 baseline group (BG) members over a six-month outcome period. Members were identified retrospectively using identical criteria during one year prior to implementation of the program.

Improving the quality of diabetes care: a behavioral health intervention.

The purpose of this study is to assess the impact of a group-based program on glucose control for adults with diabetes. Ninety-two adults completed the program aimed at identifying and overcoming barriers to diabetes self-management with the use of behavioral strategies. A comparison group consisted of 275 adults with diabetes not participating in the program matched for age, gender, type of insurance coverage, and initial hemoglobin Alc (HbAlc) result.

Reducing 30-day inpatient psychiatric recidivism and associated costs through intensive case management.

Purpose Of The Study: Intensive case management (ICM) holds promise in reducing 30-day inpatient psychiatric recidivism and associated costs. The purpose of this study is to determine the impact of ICM on 30-day inpatient psychiatric recidivism and associated costs among adult health plan members at elevated risk of psychiatric hospitalization.

Primary Practice Setting: Psychiatric settings.

Overcoming challenges to integrating behavioral health into primary care.

Integrating behavioral healthcare into the primary care setting is associated with many benefits; however, plans to integrate care must address several challenges. This article identifies the challenges of integrating behavioral health specialists into primary care and describes strategies used to overcome these challenges.

Predicting psychiatric emergency room recidivism.

To address the need to reduce psychiatric emergency-room (ER) recidivism and to promote continuity of care, this study developed a model using administratively obtainable variables to predict psychiatric ER visits in the six months following an index ER visit for a psychiatric condition. Data on member characteristics, preindex psychiatric ER use, index ER information, and postindex utilization for 1,029 adult HMO members visiting the ER for a psychiatric condition were collected and randomly divided in half. A regression model predicting psychiatric ER visits in the six months following the initial psychiatric ER visit was developed in the first data set and tested in the second.

Reducing the number of emergency department visits and costs associated with anxiety: a randomized controlled study.

Objective: To demonstrate the economic effects of an intervention for members discharged from the emergency department (ED) with anxiety diagnoses.

Study Design: Randomized controlled study.

Methods: Adults with commercial, Medicare, or Medicaid insurance coverage enrolled in a health maintenance organization and discharged from an ED with anxiety diagnoses were randomly assigned to receive usual care (n = 300) or a stepped-care intervention (n = 307).

Predicting future hospital utilization for mental health conditions.

To develop a model using administrative variables to predict number of days in the hospital for a mental health condition in the year after discharge from a mental health hospitalization. Background, index hospitalization and preindex inpatient, emergency room, and outpatient utilization information were collected for 766 adult members discharged from a mental health hospitalization during a 1-year period. A regression model was developed to predict hospitalized days for a mental health condition in the year after discharge.

Improving continuity of care: success of a behavioral health program.

This article documents the quality improvement process implemented by HIP Health Plan of New York (HIP) for the behavioral health continuity-of-care measure, Follow-Up After Hospitalization for Mental Illness. This Health Plan Employer Data and Information Set (HEDIS) measure identifies the percentage of members who receive psychiatric follow-up care after their hospital discharge. Studies indicate that post-hospitalization psychiatric follow-up care is an effective method for reducing hospital readmissions.