Transition to mental health carveouts disrupts care for most fragile

A study in the May 8 edition of the New England Journal of Medicine describes the disruptive effects that a transition to a mental health "carveout" system in Tennessee had on antipsychotic therapy for people with schizophrenia, and how lessons about the chaotic transition could help other states' programs.

"When the system of preventive mental health for fragile patients is changed, care has to be taken to prevent disruption of services such as community services essential to help patients comply with their medication regimens," says Wayne Ray, Ph.D., professor of preventive medicine at Vanderbilt University Medical Center. "In these patients, loss of compliance can have severe consequences.

"Also, it was clear that carve-out programs need to include incentives for increasing the quality of care as well as containing costs. This was missing in the original Tennessee carveout," he says. Sixteen other states currently have similar carveout systems.

In a cost-saving move in 1996, thousands of Tennesseans receiving Medicaid for mental health services were transferred into two behavioral health maintenance organizations under a program called TennCare Partners, creating a mental health carveout.

Ray, James Daugherty, an data analyst at Vanderbilt, and Dr. Keith Meador at Duke poured over the records of 8,000 of these mental health patients, most of whom had schizophrenia. They studied antipsychotic therapy during a six-month period of care prior to the transition to establish a baseline and compared those findings to the first year of care following the move.

The post-transitional group missed a statistically significant higher percentage of patients who missed more than 60 days of antipsychotic therapy, including drug therapy, and they received fewer days of antipsychotic therapy overall. They were less likely to see the same physician as the patients before the transition.

It is well know that compliance with med

Contact: Clinton Colmenares
Vanderbilt University Medical Center

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