Who Is Paying the Price? Loss of Health Insurance Coverage Early in Psychosis

Dodds, Tyler J.; Phutane, Vivek H.; Stevens, Bernard; Woods, Scott W.; Sernyak, Michael J.; Srihari, Vinod H.

doi:10.1176/ps.62.8.pss6208_0878

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…STEP recently completed the first U.S. randomized controlled trial to determine the feasibility and effectiveness of this public-sector based approach to FES [ 18 ]. This trial has also collected detailed information on sources of direct and indirect cost [ 20 – 22 ] that support international data on the health economic benefits of FES.…”

Section: Introductionmentioning

confidence: 99%

“…Also, the anticipated but unclear changes in U.S. pathways over time (e.g. with ongoing reforms in access to health insurance [ 22 ]) make it vital to test any ED strategy against a control setting to disentangle the effects of an ED campaign from secular changes in the U.S. healthcare environment. Finally, FES care is a rarity in most U.S. settings and can reduce DUP in a region simply by its presence.…”

Section: Introductionmentioning

confidence: 99%

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Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study

et al. 2014

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BackgroundEarly intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. In the latter category, are teams (‘First-episode Services’ or FES) that integrate several empirically supported treatments and adapt their delivery to younger patients and caregivers. There is an urgent need to hasten access to established FES in the U.S. Despite improved outcomes for those in treatment, these FES routinely engage patients a year or more after psychosis onset. The Scandinavian TIPS study was able to effectively reduce DUP in a defined geographic catchment. The guiding questions for this study are: can a U.S. adaptation of the TIPS approach to ED substantially reduce DUP and improve outcomes beyond existing FES?Methods/DesignThe primary aim is to determine whether ED can reduce DUP in the US, as compared to usual detection. ED will be implemented by one FES (STEP) based in southern Connecticut, and usual detection efforts will continue at a comparable FES (PREPR) serving the greater Boston metropolitan area. The secondary aim is to determine whether DUP reduction can improve presentation, engagement and early outcomes in FES care. A quasi-experimental design will compare the impact of ED on DUP at STEP compared to PREPR over 3 successive campaign years. The campaign will deploy 3 components that seek to transform pathways to care in 8 towns surrounding STEP. Social marketing approaches will inform a public education campaign to enable rapid and effective help-seeking behavior. Professional outreach and detailing to a wide variety of care providers, including those in the healthcare, educational and judicial sectors, will facilitate rapid redirection of appropriate patients to STEP. Finally, performance improvement measures within STEP will hasten engagement upon referral.DiscussionSTEP-ED will test an ED campaign adapted to heterogeneous U.S. pathways to care while also improving our understanding of these pathways and their impact on early outcomes.Trial registrationClinicalTrials.gov: NCT02069925. Registered 20 February 2014.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study

et al. 2014

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“…In latter systems, such as in the U.S., strong incentives exist to shift costs between different payers with measurably adverse outcomes for patients and their families early in the course of psychotic illnesses. [83]. Also, service utilization patterns and the costs associated with them can vary between sites and across countries.…”

Section: Are Ei Services Worth the Cost?mentioning

confidence: 99%

“…Privately insured patients struggling with the emergence of a serious mental illness can rapidly lose health insurance [83] and typically arrive at the public state mental health system long after the critical period for early intervention has elapsed.…”

Section: Is Early Intervention Feasible?mentioning

confidence: 99%

Is Early Intervention for Psychosis Feasible and Effective?

Srihari

Shah

Keshavan

2012

Psychiatric Clinics of North America

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Synopsis Services that provide comprehensive, early intervention (EI) have shown promise in improving long-term outcomes in schizophrenia. This paper reviews the rationale and salient concepts relevant to understanding the growing EI literature. A selective review of studies evaluating the effectiveness of integrated EI is followed by a discussion of feasibility, especially in the U.S. context. Finally, the authors present a framework that seeks to integrate activities traditionally categorized and separated as discovery and implementation. This framework is offered as one way to advance both goals.

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“…Prior research has found that individuals with serious mental illness experience frequent insurance disruptions 22 – 24 , and individuals with schizophrenia are more likely to experience an insurance disruption – often a coverage gap – compared to other types of serious mental illness 25 . However, most studies examining insurance stability for those with schizophrenia were conducted before the ACA, limited to those with either first episode psychosis or first diagnosis of schizophrenia, or limited to young adults 22 – 24 .…”

Section: Introductionmentioning

confidence: 99%

Transitions in health insurance among continuously insured patients with schizophrenia

Ranchoff,

Jeung,

Zeber

et al. 2024

Schizophr

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Changes in health insurance coverage may disrupt access to and continuity of care, even for those who remain insured. Continuity of care is especially important in schizophrenia, which requires ongoing medical and pharmaceutical treatment. However, little is known about continuity of insurance coverage among those with schizophrenia. The objective was to examine the probability of insurance transitions for individuals with schizophrenia who were continuously insured and whether this varied across insurance types. The Massachusetts All-Payer Claims Database identified individuals with schizophrenia aged 18–64 who were continuously insured during a two-year period between 2014 and 2018. A logistic regression estimated the association of having an insurance transition – defined as having a change in insurance type – with insurance type at the start of the period, adjusting for age, sex, ZIP code in the lowest quartile of median income, and ZIP code with concentrated poverty. Overall, 15.1% had at least one insurance transition across a 24-month period. Insurance transitions were most frequent among those with plans from the Marketplace. In regression adjusted results, individuals covered by the traditional Medicaid program were 20.2 percentage points [pp] (95% confidence interval [CI]: 24.6 pp, 15.9 pp) less likely to have an insurance transition than those who were insured by a Marketplace plan. Insurance transitions among individuals with schizophrenia were common, with more than one in six people having at least one transition in insurance type during a two-year period. Given that even continuously insured individuals with schizophrenia commonly experience insurance transitions, attention to insurance transitions as a barrier to care access and continuity is warranted.

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Who Is Paying the Price? Loss of Health Insurance Coverage Early in Psychosis

Cited by 6 publications

References 17 publications

Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study

Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study

Is Early Intervention for Psychosis Feasible and Effective?

Transitions in health insurance among continuously insured patients with schizophrenia

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