Table 4.
Difference in the Pre‐Post Annual Change in Utilization, Quality of Care, and Expenditures for Medicaid Beneficiaries With Behavioral Health Conditions Enrolled in the Three Medicaid ACOs and Their Respective Comparison Group
| Outcome | Pre‐Period Adjusted Mean, ACO | Pre‐Period Adjusted Mean, CG | Post‐Period Adjusted Mean, ACO | Post‐Period Adjusted Mean, CG | Regression‐Adjusted D‐in‐D (90% CI) | Relative Difference (%) | P‐Value | Total Weighted N |
|---|---|---|---|---|---|---|---|---|
| All‐cause inpatient admissions (per 1,000 beneficiaries) | ||||||||
| Maine | 128.3 | 124.2 | 114.2 | 113.6 | −3.4 | −2.7 | 0.34 | 156,313 |
| (−9.4, 2.5) | ||||||||
| Minnesota | 141.0 | 134.3 | 140.1 | 132.0 | 3.6 | 2.6 | 0.003 | 876,307 |
| (1.6, 5.7) | ||||||||
| Vermont | 87.7 | 83.0 | 84.4 | 89.3 | −10.9 | −12.4 | <0.001 | 237,699 |
| (−15.1, −6.7) | ||||||||
| Emergency department visits (per 1,000 beneficiaries) | ||||||||
| Maine | 507.1 | 493.6 | 469.9 | 464.6 | −9.1 | −1.8 | 0.09 | 156,313 |
| (−17.9, −0.4) | ||||||||
| Minnesota | 499.9 | 444.3 | 415.0 | 387.9 | −22.8 | −4.6 | <0.001 | 876,307 |
| (−25.6, −19.9) | ||||||||
| Vermont | 444.7 | 413.6 | 392.2 | 388.2 | −27.0 | −6.1 | <0.001 | 237,699 |
| (−34.0, −20.1) | ||||||||
| 30‐day readmissions (per 1,000 discharges) | ||||||||
| Maine | 160.6 | 140.7 | 184.9 | 156.2 | 7.6 | 4.7 | 0.58 | 24,976 |
| (−15.1, 30.2) | ||||||||
| Minnesota | 167.5 | 171.2 | 182.7 | 182.7 | 1.0 | 0.6 | 0.85 | 149,830 |
| (−8.0, 10.1) | ||||||||
| Vermont | 119.6 | 129.9 | 120.5 | 128.4 | −2.6 | −2.2 | >0.99 | 19,975 |
| (−23.5, 18.2) | ||||||||
| Patients who remained on antidepressant medication for at least 84 days (%) | ||||||||
| Maine | 55.5 | 54.8 | 57.1 | 56.4 | 0.3 | 0.6 | 0.85 | 10,677 |
| (−2.5, 3.1) | ||||||||
| Minnesota | 48.1 | 49.7 | 51.3 | 52.7 | −0.3 | −0.5 | 0.60 | 96,944 |
| (−1.1, 0.6) | ||||||||
| Patients who remained on antidepressant medication for at least 180 days (%) | ||||||||
| Maine | 41.1 | 39.3 | 40.1 | 38.6 | 0.3 | 0.6 | 0.86 | 10,677 |
| (−2.2, 2.7) | ||||||||
| Minnesota | 34.1 | 35.1 | 36.0 | 38.3 | −1.4 | −4.2 | 0.002 | 96,944 |
| (−2.2, −0.7) | ||||||||
| Follow‐up within 7 days of discharge from hospitalization for mental illness (%) | ||||||||
| Maine | 70.3 | 74.1 | 70.1 | 74.8 | −1.2 | −1.7 | 0.61 | 4,591 |
| (−5.2, 2.7) | ||||||||
| Vermont | 56.1 | 59.4 | 56.8 | 61.0 | −0.1 | −0.1 | 0.98 | 6,292 |
| (−4.7, 4.6) | ||||||||
| Follow‐up within 30 days of discharge from hospitalization for mental illness (%) | ||||||||
| Maine | 90.1 | 90.9 | 89.4 | 90.6 | −0.6 | −0.6 | 0.73 | 4,591 |
| (−3.2, 2.1) | ||||||||
| Vermont | 80.0 | 81.4 | 81.1 | 81.9 | 0.7 | 0.9 | 0.74 | 6,292 |
| (−2.9, 4.4) | ||||||||
| Total expenditures (PBPM) | ||||||||
| Maine | 1138.80 | 1128.57 | 1144.19 | 1144.78 | −19.62 | −1.7 | 0.50 | 156,313 |
| (−67.46, 28.22) | ||||||||
| Minnesota | 1074.21 | 1068.12 | 1186.34 | 1307.98 | −127.73 | −11.9 | 0.09 | 710,275 |
| (Ȣ252.71, −2.76) | ||||||||
| Vermont | 945.84 | 913.83 | 1029.32 | 1045.91 | −61.77 | −6.5 | <0.001 | 237,699 |
| (−87.18, −36.36) | ||||||||
Abbreviations: ACO, accountable care organization; CG, comparison group; CI, confidence interval; D‐in‐D, difference‐in‐differences; ME, Maine; MN, Minnesota; PBPM, per beneficiary per month; VT, Vermont.
For Maine, the implementation period is August 2014–July 2016 and the baseline period is August 2011–July 2014. For Minnesota, the implementation period is 2013–2016 for the utilization outcomes and 2013–2015 for total expenditures and the baseline period is 2010–2012. For Vermont, the implementation period is 2014–2016 and the baseline period is 2011–2013.
Source: RTI analysis of Maine, Minnesota, and Vermont Medicaid data, 2011–2016; RTI analysis of Minnesota All Payer Claims Database data, 2011–2015.