PMID- 32128686
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20211102
IS  - 1525-1497 (Electronic)
IS  - 0884-8734 (Print)
IS  - 0884-8734 (Linking)
VI  - 35
IP  - 11
DP  - 2020 Nov
TI  - Effects of Maryland's Affordable Care Act Medicaid Health Home Waiver on Quality 
      of Cardiovascular Care Among People with Serious Mental Illness.
PG  - 3148-3158
LID - 10.1007/s11606-020-05690-9 [doi]
AB  - BACKGROUND: Nineteen US states and D.C. have used the Affordable Care Act 
      Medicaid health home waiver to create behavioral health home (BHH) programs for 
      Medicaid beneficiaries with serious mental illness (SMI). BHH programs integrate 
      physical healthcare management and coordination into specialty mental health 
      programs. No studies have evaluated the effects of a BHH program created through 
      the Affordable Care Act waiver on cardiovascular care quality among people with 
      SMI. OBJECTIVE: To study the effects of Maryland's Medicaid health home waiver 
      BHH program, implemented October 1, 2013, on quality of cardiovascular care among 
      individuals with SMI. DESIGN: Retrospective cohort analysis using Maryland 
      Medicaid administrative claims data from July 1, 2010, to September 30, 2016. We 
      used marginal structural modeling with inverse probability of treatment weighting 
      to account for censoring and potential time-dependent confounding. PARTICIPANTS: 
      Maryland Medicaid beneficiaries with diabetes or cardiovascular disease (CVD) 
      participating in psychiatric rehabilitation programs, the setting in which BHHs 
      were implemented. To qualify for psychiatric rehabilitation programs, individuals 
      must have SMI. The analytic sample included BHH and non-BHH participants, 
      N = 2605 with diabetes and N = 1899 with CVD. MAIN MEASURES: Healthcare 
      Effectiveness Data and Information Set (HEDIS) measures of cardiovascular care 
      quality including annual receipt of diabetic eye and foot exams; HbA1c, diabetic 
      nephropathy, and cholesterol testing; and statin therapy receipt and adherence 
      among individuals with diabetes, as well as HEDIS measures of annual receipt of 
      cholesterol testing and statin therapy and adherence among individuals with CVD. 
      KEY RESULTS: Relative to non-enrollment, enrollment in Maryland's BHH program was 
      associated with increased likelihood of eye exam receipt among individuals with 
      SMI and co-morbid diabetes, but no changes in other care quality measures. 
      CONCLUSIONS: Additional financing, infrastructure, and implementation supports 
      may be needed to realize the full potential of Maryland's BHH to improve 
      cardiovascular care for people with SMI.
FAU - McGinty, Emma E
AU  - McGinty EE
AD  - Department of Health Policy and Management , Johns Hopkins Bloomberg School of 
      Public Health, Baltimore, MD, USA. bmcginty@jhu.edu.
FAU - Stone, Elizabeth M
AU  - Stone EM
AD  - Department of Health Policy and Management , Johns Hopkins Bloomberg School of 
      Public Health, Baltimore, MD, USA.
AD  - Division of General Internal Medicine, Johns Hopkins School of Medicine, 
      Baltimore, MD, USA.
FAU - Kennedy-Hendricks, Alene
AU  - Kennedy-Hendricks A
AD  - Department of Health Policy and Management , Johns Hopkins Bloomberg School of 
      Public Health, Baltimore, MD, USA.
FAU - Bandara, Sachini
AU  - Bandara S
AD  - Department of Health Policy and Management , Johns Hopkins Bloomberg School of 
      Public Health, Baltimore, MD, USA.
FAU - Murphy, Karly A
AU  - Murphy KA
AD  - Division of General Internal Medicine, Johns Hopkins School of Medicine, 
      Baltimore, MD, USA.
FAU - Stuart, Elizabeth A
AU  - Stuart EA
AD  - Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 
      Baltimore, MD, USA.
FAU - Rosenblum, Michael A
AU  - Rosenblum MA
AD  - Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 
      Baltimore, MD, USA.
FAU - Daumit, Gail L
AU  - Daumit GL
AD  - Division of General Internal Medicine, Johns Hopkins School of Medicine, 
      Baltimore, MD, USA.
LA  - eng
GR  - R24MH102822/MH/NIMH NIH HHS/United States
GR  - K01MH106631/MH/NIMH NIH HHS/United States
GR  - R24 MH102822/MH/NIMH NIH HHS/United States
GR  - P50MH115842/MH/NIMH NIH HHS/United States
GR  - P50 MH115842/MH/NIMH NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20200303
PL  - United States
TA  - J Gen Intern Med
JT  - Journal of general internal medicine
JID - 8605834
SB  - IM
CIN - J Gen Intern Med. 2020 Nov;35(11):3421. PMID: 32869205
MH  - Humans
MH  - Maryland/epidemiology
MH  - Medicaid
MH  - *Mental Disorders/epidemiology/therapy
MH  - *Mental Health Services
MH  - Patient Protection and Affordable Care Act
MH  - Retrospective Studies
MH  - United States/epidemiology
PMC - PMC7661675
COIS- The authors declare that they have no conflict of interest.
EDAT- 2020/03/05 06:00
MHDA- 2021/05/15 06:00
PMCR- 2021/11/01
CRDT- 2020/03/05 06:00
PHST- 2019/07/12 00:00 [received]
PHST- 2020/01/29 00:00 [accepted]
PHST- 2020/03/05 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/03/05 06:00 [entrez]
PHST- 2021/11/01 00:00 [pmc-release]
AID - 10.1007/s11606-020-05690-9 [pii]
AID - 5690 [pii]
AID - 10.1007/s11606-020-05690-9 [doi]
PST - ppublish
SO  - J Gen Intern Med. 2020 Nov;35(11):3148-3158. doi: 10.1007/s11606-020-05690-9. 
      Epub 2020 Mar 3.