Table 3.

Changes in Clinical Event Rates After Reaching the Gap Threshold

	Standard Gap			No Gap (LIS)
Schizophrenia	Rate*	HR	99.5% CI	Rate*	HR	99.5% CI
All Hospitalizations	68.7	1.32	(1.06, 1.65)	82.5	1.10	(0.91, 1.32)
MH Hospitalizations	61.0	1.29	(1.02, 1.64)	73.0	1.17	(0.96, 1.42)
Non-MH Hospitalizations	7.7	1.58	(0.81 3.08)	9.5	0.69	(0.41 1.18)
All ED visits	131.7	1.14	(0.97, 1.34)	192.3	1.04	(0.92, 1.17)
MH ED visits	85.6	1.13	(0.92,1.38)	114.6	1.06	(0.91, 1.24)
Non-MH ED visits	46.1	1.16	(0.88 1.53)	77.7	1.00	(0.83 1.21)
Bipolar disorder	Rate*	HR	99.5% CI	Rate*	HR	99.5% CI
All Hospitalizations	61.1	1.45	(1.16, 1.82)	67.3	0.98	(0.76, 1.26)
MH Hospitalizations	47.3	1.52	(1.18, 1.97)	54.7	0.99	(0.75, 1.30)
Non-MH Hospitalizations	13.8	1.22	(0.76 1.97)	12.5	0.96	(0.53 1.72)
All ED visits	128.9	1.17	(1.00, 1.37)	217.6	0.96	(0.84, 1.10)
MH ED visits	71.3	1.35	(1.10, 1.66)	107.0	0.89	(0.74, 1.08)
Non-MH ED visits	57.6	0.98	(0.77 1.24)	110.6	1.03	(0.85 1.24)
No Mental Health Diagnosis	Rate*	HR	99.5% CI	Rate*	HR	99.5% CI
Non-MH Hospitalizations	19.7	0.92	(0.51, 1.66)	22.4	1.21	(0.70, 2.10)
Non-MH ED visits	38.9	1.08	(0.73 1.61)	72.6	0.83	(0.61 1.15)

^*Unadjusted annual rate in 2007 per 100 patients

Notes: To examine time to hospitalizations and emergency department (ED) visits we used the Anderson-Gill extension of the Cox model; we fit separate models for the Gap and No Gap groups. These models include a time-varying indicator for being in the first 30 days from the reaching the gap threshold (transition period) and being >=31 days from the gap threshold; the models also adjust for gender, age, and the Part D (RxHCC) risk score. These tables present hazard ratios (HR) for being >=31 days from reaching the gap threshold vs. pre-gap threshold. In sensitivity analyses we adjusted for the CMS-HCC risk scores, which predict spending in Parts A and B, instead of the RxHCC score; conclusions were the same.