A Four-System Comparison of Patients With Chronic Illness: The Military Health System, Veterans Health Administration, Medicaid, and Commercial Plans

Gibson, Teresa B.; Lee, Todd A.; Vogeli, Christine; Hidalgo, Julia; Carls, Ginger Smith; Sredl, Katherine; DesHarnais, Susan; Marder, William D.; Weiss, Kevin B.; Williams, Thomas V.; Shields, Alexandra E.

doi:10.7205/milmed-d-03-7808

Cited by 19 publications

(13 citation statements)

References 7 publications

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“…36 Diabetes is a critical issue for the MHS, with a prevalence of 5% among MHS enrollees and even greater prevalence rates in overweight (8-11%) and obese (16-37%) retirees and their dependents. [37][38][39][40][41][42] The total annual cost of TRICARE beneficiaries aged 20-65 years with diagnosed diabetes was approximately $300 million in 2006; the average additional medical cost per beneficiary diagnosed with diabetes was $2150 annually. 43,44 In an effort to improve outcomes and reduce costs associated with diabetes, the U.S. Air Force Wilford Hall Medical Center (WHMC) implemented the CCM in 2006 through the Diabetes Outreach Clinic (DOC), which restructured health care for diabetic beneficiaries by delivering services through a single, centralized location.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Implementing the Chronic Care Model for Diabetes Care in a Military Population

Kuo

Bryce

Zgibor

et al. 2011

J Diabetes Sci Technol

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Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Implementing the Chronic Care Model for Diabetes Care in a Military Population

Kuo

Bryce

Zgibor

et al. 2011

J Diabetes Sci Technol

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“…1 The majority of Medicaid enrollees have poor health and have a high prevalence of chronic medical conditions. 5 Some of these chronic conditions, especially depression, migraine, and schizophrenia, might share common underlying neuropathologic or physiologic dysfunction with epilepsy. 11 Other conditions, including brain tumor, 12 stroke, 13 and TBI, 14 are well-known risk factors for symptomatic epilepsy.…”

mentioning

confidence: 99%

“…Because of the overrepresentation of disabling physical and/or mental ailments in the Medicaid population, 5 several of which are risk factors for epilepsy, subjects were determined as having preexisting disability and/or comorbid conditions, including brain tumor, depression, developmental disorders, migraine, schizophrenia, stroke, and traumatic brain injury (TBI), when at least one of these conditions occurred before the epilepsy index date (figure e-1). The preexisting disability was determined by the presence of disability status in the enrollment files.…”

mentioning

confidence: 99%

Incidence and prevalence of treated epilepsy among poor health and low-income Americans

et al. 2013

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Objectives: To determine the incidence and prevalence of treated epilepsy in an adult Medicaid population.Methods: We performed a retrospective, dynamic cohort analysis using Ohio Medicaid claims data between 1992 and 2006. Individuals aged 18-64 years were identified as prevalent cases if they had $2 claims of epilepsy (ICD-9-CM: 345.xx) or $3 claims of convulsion (ICD-9-CM: 780.3 or 780.39) and $2 claims of antiepileptic drugs. Incident cases were required to have no epilepsy or convulsion claims for $5 years before epilepsy diagnosis. Subjects were determined as having preexisting disability and/or comorbid conditions, including brain tumor, depression, developmental disorders, migraine, schizophrenia, stroke, and traumatic brain injury, when at least one of these conditions occurred before epilepsy onset.Results: There were 9,056 prevalent cases of treated epilepsy in 1992-2006 and 1,608 incident cases in 1997-2006. The prevalence was 13.2/1,000 (95% confidence interval, 13.0-13.5/ 1,000). The incidence was 362/100,000 person-years (95% confidence interval, 344-379/ 100,000 person-years). The incidence and prevalence were significantly higher in men, in older people, in blacks, and in people with preexisting disability and/or comorbid conditions. The most common preexisting conditions in epilepsy subjects were depression, developmental disorders, and stroke, whereas people with brain tumor, traumatic brain injury, and stroke had the higher risk of developing epilepsy. Conclusions:The Medicaid population has a high incidence and prevalence of epilepsy, in an order of magnitude greater than that reported in the US general population. This indigent population carries a disproportionate amount of the epilepsy burden and deserves more attention for its health care needs and support services. Medicaid, financed jointly by the US federal and state governments, provides health care coverage for low-income families and for individuals with disabilities. Medicaid is the single largest health insurer in the United States with an average monthly enrollment of nearly 60 million beneficiaries.1 In general, subjects enrolled in Medicaid are educationally and socioeconomically disadvantaged and a large number of them have disabling physical and/or mental ailments, several of which are also risk factors for epilepsy. However, no study, to our knowledge, has specifically examined the incidence and/or prevalence of epilepsy in this subgroup of the US population. Both incidence and prevalence data on Medicaid beneficiaries are crucial for the complete understanding of the burden of epilepsy in the United States. Moreover, this information is necessary for planning appropriate actions or interventions to provide needed health care and support services for this highly vulnerable subgroup of the population. This study was designed to estimate the incidence and prevalence of epilepsy in the Medicaid population. We

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“…Studies have shown that Medicaid patients have higher rates of depression 61 as well as higher rates of antipsychotic use as compared to commercially insured populations. 62 At the same time, Medicaid enrollees often receive lower quality of care over a range of quality measures.…”

Section: Resultsmentioning

confidence: 99%

Ten-Year Trends in Quality of Care and Spending for Depression

Fullerton

Busch²,

Normand³

et al. 2011

Arch Gen Psychiatry

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Context Over the past decade, the introduction of generic versions of newer antidepressants and the release of FDA-warnings regarding suicidality in children, adolescents, and young adults may have had an impact on cost and quality of depression treatment. Objectives To examine longitudinal trends in service use, spending, and treatment quality for depression. Design Observational, trend study. Setting Florida, Medicaid enrollees from July 1996 to June 2006. Subjects Annual cohorts aged 18-64 diagnosed with depression. Main Outcome Measures Mental-health spending adjusted for inflation and case mix and components of mental-health spending, including inpatient, outpatient, and medication expenditures. Quality measures included measures of medication adherence, psychotherapy, and follow-up visits. Results Mental-health spending increased from an average of $2802 per enrollee to $3610 over this time period (29% increase). This increase occurred despite a mean decrease in inpatient spending (from $641 per enrollee to $373) and was driven primarily by an increase in pharmaceutical spending (up 110%) the bulk of which was due to spending on antipsychotics (up 949%). The percentage of enrollees with depression who were hospitalized decreased from 57% to 37% and the percentage using psychotherapy decreased from 9% to 5%. Antidepressant use increased from 82% to 87%, anxiety medication use was unchanged at 64%, and antipsychotic use increased from 27% to 42%. Changes in treatment quality were mixed, with measures of antidepressant use improving slightly, measures examining follow-up visits decreasing, and measures of psychotherapy utilization fluctuating. Conclusions Over a ten-year period, we found a substantial increase in spending for enrollees with depression associated with minimal improvements in quality of care. Antipsychotic use contributed significantly to the increase in spending while contributing little to traditional measures of quality.

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A Four-System Comparison of Patients With Chronic Illness: The Military Health System, Veterans Health Administration, Medicaid, and Commercial Plans

Cited by 19 publications

References 7 publications

Cost-Effectiveness of Implementing the Chronic Care Model for Diabetes Care in a Military Population

Cost-Effectiveness of Implementing the Chronic Care Model for Diabetes Care in a Military Population

Incidence and prevalence of treated epilepsy among poor health and low-income Americans

Ten-Year Trends in Quality of Care and Spending for Depression

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