According to the U.S. Agency for Healthcare Research and Quality (AHRQ), about one in eight emergency department (ED) visits in the United States are for treatment of mental health or substance use disorders. Although these conditions can often be effectively managed with outpatient care, recent AHRQ research revealed a 55.5 percent increase in ED visits for these conditions between 2006 and 2013. State Medicaid programs pay a substantial share of the cost, and states that expanded Medicaid in 2014 may be shouldering even more of the financial burden.
A Mathematica study published in Psychiatric Services highlights an important opportunity to address the issue. Several existing studies suggest that receiving outpatient follow-up care after ED visits involving mental and substance use disorders can reduce the likelihood of returning to the ED in the future. However, Mathematica’s research reveals that about one-quarter of the patients on Medicaid who visited the ED for a mental health issue—and about one-third of those who visited with a substance use disorder—did not receive outpatient follow-up care within 30 days. Furthermore, characteristics including age, race or ethnicity, geographic setting, and clinical conditions were all associated with the beneficiary’s likelihood of getting this follow-up care. The findings can give state Medicaid programs a point of focus in their efforts to increase follow-up care and thereby reduce the number of repeat visits to the emergency department.
The need for this kind of follow-up care extends beyond patients in the Medicaid program. A quality measure that allows us to capture the extent of follow-up care was developed in conjunction with Mathematica’s study and is being incorporated into reporting for the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set. States participating in the Substance Abuse and Mental Health Service Administration’s Certified Community Behavioral Health Clinic demonstration are required to report the measure. This quality measure may also be widely reported by managed care plans and other entities in the future, allowing for direct comparisons between the Medicaid population and the fee-for-service population.
Mathematica staff conduct rigorous research on a range of topics in the areas of mental health and substance use. We combine expertise in evaluations of the most effective care with strong capabilities in data collection and analysis, and our work helps build the evidence base for effective care practices and better patient outcomes.