Sunday, October 14, 2012

Maryland Medicaid: Behavioral health problems predict skyrocketing medical hospitalizations

Earlier this summer the Maryland Department of Health and Mental Hygiene released four years of aggregated data on Maryland Medicaid patients and some measures of health care utilization, such as hospitalizations. The data can be found here (look at the July 11 meeting materials called Data Book). This is in the context of Maryland's attempts to integrate mental health, addictions, and somatic health (see Crazy Busy for more details).

The data show hospital admissions for the top 25 conditions -- such as stroke, diabetes, pneumonia, etc -- and further break up these data into four groups of people:

  • people who also have a mental health disorder
  • people who also have a substance use disorder
  • people who have both a mental health and a substance use disorder
  • people who have neither of these conditions (ie, just a somatic disorder, like asthma or diabetes)

Taking this data and analyzing it in more detail led to some amazing discoveries that are buried in the data tables. For example, in 2011, adult patients in Maryland Medicaid's HealthChoice program who had co-occurring mental health (MH) and substance use (SU) disorders were admitted to hospitals 800-1500% more often than those without these co-occurring conditions -- hospitalized 8-15 times more often for things like pneumonia, asthma, diabetes, epilepsy, and cellulitis.

That is worth saying one more time:
Patients with both mental health and substance use disorders were hospitalized 8-15 times more often for things like pneumonia, asthma, diabetes, epilepsy, and cellulitis.
Here is a graph demonstrating this amazing connection. People with co-occurring mental health problems were admitted 2-4 times more often for these 6 types of medical conditions, and people with co-occurring substance use problems were admitted 4-7 times more often. This is based on claims data submitted to Medicaid and analyzed by the Hilltop Institute. The data are normalized such those without mental health or addiction comorbidity have a relative risk of 1 for hospitalization


The six conditions are the primary diagnoses as indicated by the Medicaid data: epilepsy; HIV-related illness; cellulitis/septicemia; congestive heart failure; respiratory conditions (bronchitis, pneumonia, asthma, and COPD); and diabetes mellitis.

It's no wonder there is data that people with chronic mental health conditions treated in the public health system die 25 years earlier.

If there was ever a reason to better integrate mental health care, addiction treatment, and primary care, this is it.

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