Care Management Intervention to Address Determinants of Health for Individuals With Multiple Behavioral Health Readmission

Shari L Hutchison; Amy D Herschell; Jamie F Edwards; Irina Karpov; Deborah S Wasilchak; Matthew O Hurford

doi:10.1097/NCM.0000000000000531

Care Management Intervention to Address Determinants of Health for Individuals With Multiple Behavioral Health Readmission

Prof Case Manag. 2022 Mar-Apr;27(2):47-57. doi: 10.1097/NCM.0000000000000531.

Authors

Shari L Hutchison^{1

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6}, Amy D Herschell^{1

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6}, Jamie F Edwards^{1

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6}, Irina Karpov^{1

2

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6}, Deborah S Wasilchak^{1

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3

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6}, Matthew O Hurford^{1

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4

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6}

Affiliations

¹ Shari L. Hutchison, MS, PMP, is the Project Director, Community Care Behavioral Health Organization, has over 25 years of experience in program evaluation, working collaboratively with health care providers and other stakeholders to implement evidence-based and promising practices in behavioral health. Ms. Hutchison earned dual Bachelor of Science degrees from Syracuse University in New York and a Master of Science in Psychology from the University of Pittsburgh.
² Amy D. Herschell, PhD, is the Senior Director of Research Strategy and Outcomes Management for Community Care Behavioral Health Organization. Dr. Herschell has served as an investigator for several externally funded grants and has published extensively on topics related to implementation science, workforce development, evidence-based practices, and training approaches.
³ Jamie F. Edwards, LCSW, is the Senior Director, Care Management & Customer Service, Community Care Behavioral Health Organization, oversees and provides support to the Care Management and Customer Service Departments. Throughout her tenure with the organization, she has held numerous clinical leadership positions. Her commitment to the helping profession began in the Philadelphia area where Jamie worked to empower individuals, groups, and communities within local human service agencies.
⁴ Irina Karpov, MS, is the Statistician, Community Care Behavioral Health Organization, received her Master of Science degree in biostatistics from the University of Pittsburgh in 2006. Her previous experience includes analysis and data management in the areas of general internal medicine and behavioral health. Ms. Karpov currently provides statistical expertise to the UPMC Insurance Services Division.
⁵ Deborah S. Wasilchak, MA, is the Senior Vice President, Chief Clinical Administrative Officer, UPMC Insurance Services Division and Chief Program Officer, Community Care Behavioral Health Organization, a licensed psychologist, began her work at Community Care in 2000, overseeing the management of community-based services for children and families. As the organization grew, Ms. Wasilchak's role evolved to include clinical programming and innovation, network and contract management, and government relations.
⁶ Matthew O. Hurford, MD, is the President and Chief Executive Officer, Community Care Behavioral Health Organization, is a board-certified psychiatrist and has worked in public sector psychiatry for nearly 20 years holding various leadership positions in academic, government, and managed care systems including, most recently, serving as Community Care's Chief Medical Officer and Vice President of Medical Affairs. He served as an Assistant Professor and is now a Clinical Associate faculty member at the Perelman School of Medicine at the University of Pennsylvania's Center for Mental Health Policy and Services Research.

PMID: 35099417
DOI: 10.1097/NCM.0000000000000531

Abstract

Purpose of study: To examine the effectiveness of a care management intervention to decrease readmissions and to better understand clinical and social determinants associated with readmission.

Primary practice setting: Inpatient mental health (MH) and substance use disorder (SUD) facilities, nonhospital SUD withdrawal management and rehabilitation facilities.

Methodology and sample: The authors identified 3,950 Medicaid-enrolled individuals who received the intervention from licensed clinical staff of a behavioral health managed care organization; 2,182 individuals were eligible but did not receive the intervention, for treatment as usual (TAU). We used logistic regression to examine factors associated with readmission. Determinants of readmission were summarized through descriptive tests.

Results: The intervention was associated with lower readmissions to SUD facilities compared with TAU (6.0% vs. 8.6%, p = .0002) and better follow-up to aftercare. Controlling for clinical differences between groups, regression results found increased odds of readmission for male gender (odds ratio [OR]: 1.33; 95% confidence interval [CI]: 1.16-1.52, p < .0001) and dual MH and SUD diagnoses (OR: 1.52; CI: 1.29-1.79, p < .0001). Prior inpatient and case management services were also associated with increased odds for readmission. In the regression model, the intervention was not associated with decreased odds for readmission. Individuals with readmission (n = 796) were more likely to report being prescribed psychotropic medication and having housing difficulties and less likely to report having a recovery plan than those without readmission.

Implications for case management practice: Characteristics of Medicaid populations with hospitalization may contribute to readmission, which may be mitigated through care management intervention.

MeSH terms

Case Management
Humans
Male
Medicaid
Mental Health
Patient Readmission*
Substance-Related Disorders*
United States