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Schizophrenia, Co-occurring Substance use Disorders and Quality of Care: The Differential Effect of a Managed Behavioral Health Care Carve-out

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Abstract

This study explores the differential effect of a managed behavioral health Carve-Out (CO) on outpatient treatment quality for persons with schizophrenia (SCHZ) alone and co-occurring substance use disorders (SUD) (SCHZ+SUD). We used claims data from a state Medicaid program and employed a retrospective, quasi-experimental design with logit and difference in difference formula regression models. The results show the CO was associated with greater changes in treatment quality for the SCHZ population, compared to the SCHZ+SUD population. Most pronounced across both populations were decrements in receiving the psychosocial treatments for enrollees in the CO arrangement.

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Acknowledgements

We gratefully acknowledge funding from the NIMH (R01MH62028, R01MH62028: Drs. Busch and Frank; and R01MH59254: Dr. Frank), NIDA (K08 DA00407: Dr. Greenfield; 2 P50 DA10233-06A2: Drs. Frank and Greenfield), the McLean Hospital Maria Lorenz-Pope Award (Dr. Busch) and the National Center on Minority Health and Health Disparities (Dr. Busch). The funding organizations had no role in the collection, analysis or interpretation of the data. They also had no role in the preparation, review or approval of this manuscript. We also thank Christina Fu, Ph.D. for her programming expertise on this project.

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Authors and Affiliations

  1. Alcohol and Drug Abuse Treatment Program and the Department of Health Care Policy, McLean Hospital and Harvard Medical School, Proctor Building, 115 Mill St, Belmont, MA, 02446, USA

    Alisa B. Busch

  2. Department of Health Care Policy, Harvard Medical School and National Bureau of Economic Research, Boston, MA, USA

    Richard G. Frank

  3. Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA

    Anthony F. Lehman

  4. Alcohol and Drug Abuse Treatment Program, McLean Hospital and Harvard Medical School, Proctor Building, Rm. 310, 115 Mill St, Belmont, MA, 02446, USA

    Shelly F. Greenfield

Authors
  1. Alisa B. Busch
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  2. Richard G. Frank
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  3. Anthony F. Lehman
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  4. Shelly F. Greenfield
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Corresponding author

Correspondence to Alisa B. Busch.

Additional information

An earlier version of this analysis was presented on June 24, 2004 at the Co-occurring Conditions Conference sponsored by NIMH, NIDA, NIAAA, AHRQ, HRSA AND SAMHSA.

Appendix

Appendix

Appendix 1 Pre and Post CO population description (before matching)
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Appendix 2 Effect of CO on receiving quality measures: interaction term of region and time
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Busch, A.B., Frank, R.G., Lehman, A.F. et al. Schizophrenia, Co-occurring Substance use Disorders and Quality of Care: The Differential Effect of a Managed Behavioral Health Care Carve-out. Adm Policy Ment Health 33, 388–397 (2006). https://doi.org/10.1007/s10488-006-0045-3

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  • DOI: https://doi.org/10.1007/s10488-006-0045-3

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