Impact of supportive housing health homes program on medicaid utilization for persons diagnosed with HIV (PDWH).

ABSTRACTUnstable housing among persons diagnosed with HIV (PDWH) has been consistently linked to poor HIV-related care engagement. We examined the relationship between enrollment in a supportive housing program and health care utilization (use of outpatient services, emergency department (ED) visits, and hospitalizations) for a group of unstably housed, Medicaid and Health Homes (HH)-enrolled PDWH in New York State. We analyzed monthly longitudinal data consisting of linked supportive housing data, HH data, and Medicaid claims from New York State (excluding New York City) between 2012 and 2017 using time series models. Participants who had at least six consecutive months of supportive housing at month t had 20% higher odds of using an outpatient service, 19% lower odds of visiting the ED, and 24% lower odds of being hospitalized compared to those with less than six consecutive months of supportive housing after adjusting for covariates. Supportive housing may promote better medical management by increasing outpatient visits among chronically homeless PDWH.

Effects of a New York Medicaid Care Management Program on Substance Use Disorder Treatment Services and Medicaid Spending: Implications for Defining the Target Population.

AIMS: We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services' utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year. METHODS: We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed. RESULTS: CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = -1518, -391) and reduced days of detox utilization by about 1.0 days (95% CI = -1.9, -0.1) among HFS. CONCLUSION: Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients.

Effects of Medicaid Health Homes among people with substance use disorder and another chronic condition on health care utilization and spending: Lessons from New York State.

INTRODUCTION: New York State implemented a Health Homes (HH) care management program to facilitate access to health services for Medicaid enrollees with multiple chronic conditions. This study assessed the impact of HH on health care utilization outcomes among enrollees who have substance use disorder (SUD). METHODS: Using HH enrollment data and Medicaid claims data 1 year before and after enrollment, this study compared HH enrollees who enrolled between 2012 and 2014 to a statistically matched comparison group created with propensity score methods. Analyses used generalized gamma models, logistic regression models, and difference-in-differences analyses to assess the impact of HH on general (all-cause) health care and SUD-related outpatient, emergency department (ED), hospitalization, and detoxification utilization as well as total Medicaid cost. RESULTS: The sample consisted of 41,229 HH enrollees and a comparison group of 39,471 matched patients. HH-enrolled patients who had SUD utilized less SUD-related ED services (average marginal effect (AME) = -1.85; 95% CI = -2.45, -1.24), SUD-related hospitalizations (AME = -1.28; 95% CI: -1.64, -0.93), and detoxification services (AME = -1.30; 95% CI = -1.64, -0.96), relative to the comparison group during the 1 year post-HH enrollment. SUD-related outpatient visits did not change significantly (AME = -0.28; 95% CI = -0.76, 0.19) for enrollees, but general health care outpatient visits increased (AME = 1.63; 95% CI = 1.33, 1.93). CONCLUSION: These findings provide preliminary evidence that care management programs can decrease ED visits and hospitalizations among people with SUD.

Substance Use Disorders and Diabetes Care: Lessons From New York Health Homes.

BACKGROUND: Individuals that have both diabetes and substance use disorder (SUD) are more likely to have adverse health outcomes and are less likely to receive high quality diabetes care, compared with patients without coexisting SUD. Care management programs for patients with chronic diseases, such as diabetes and SUD, have been associated with improvements in the process and outcomes of care. OBJECTIVE: The aim was to assess the impact of having coexisting SUD on diabetes process of care metrics. RESEARCH DESIGN: Preintervention/postintervention triple difference analysis. SUBJECTS: Participants in the New York State Medicaid Health Home (NYS-HH) care management program who have diabetes and a propensity-matched comparison group of nonparticipants (N=37,260). MEASURES: Process of care metrics for patients with diabetes: an eye (retinal) exam, HbA1c test, medical attention (screening laboratory measurements) for nephropathy, and receiving all 3 in the past year. RESULTS: Before enrollment in NYS-HH, individuals with comorbid SUD had fewer claims for eye exams and HbA1c tests compared with those without comorbid SUD. Diabetes process of care improvements associated with NYS-HH enrollment were larger among those with comorbid SUD [eye exam: adjusted odds ratio (AOR)=1.08; 95% confidence interval (CI): 1.01-1.15]; HbA1c test: AOR=1.20 (95% CI: 1.11-1.29); medical attention for nephropathy: AOR=1.21 (95% CI: 1.12-1.31); all 3: AOR=1.09 (95% CI: 1.02-1.16). CONCLUSIONS: Individuals with both diabetes and SUD may benefit moderately more from care management than those without comorbid SUD. Individuals with both SUD and diabetes who are not enrolled in care management may be missing out on crucial diabetes care.

Predictors of Medication Utilization for Opioid Use Disorder Among Medicaid-Insured HIV Patients in New York.

BACKGROUND AND OBJECTIVES: This paper investigates the prevalence and predictors for opioid use disorder (OUD) pharmacotherapy utilization for Medicaid-insured patients with human immunodeficiency virus (HIV) in New York. METHODS: We identified patients with HIV and OUD in 2014 in the New York State Medicaid claims data (n = 5621). The claims were used to identify individual client medication for addiction treatment (MAT) utilization, demographic information, and other medical and psychiatric health conditions. The logistic regression analyses were performed to explore the potential predictors of MAT service utilization among people with HIV and OUD. RESULTS: Of 5621 identified patients with HIV and OUD, 3647 (65%) received some type of MAT. Eighty-seven percent of treated patients received methadone while 10% received buprenorphine and 3% utilized both the therapies. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: A substantial number of patients with HIV and OUD did not receive MAT. Findings suggest that there are opportunities to improve OUD care for patients with HIV and OUD, particularly among the younger generation, blacks, individuals living outside of New York City, and among those with serious psychiatric conditions. This initial study suggests that an additional research is needed to better understand how the gap in care affects this population. (Am J Addict 2020;29:151-154).

Validation of an Optimized Algorithm for Identifying Persons Living With Diagnosed HIV From New York State Medicaid Data, 2006-2014.

Algorithms are regularly used to identify persons living with diagnosed human immunodeficiency virus (HIV) (PLWDH) in Medicaid data. To our knowledge, there are no published reports of an HIV algorithm from Medicaid claims codes that have been compared with an HIV surveillance system to assess its sensitivity, specificity, positive predictive value, and negative predictive value in identifying PLWDH. Therefore, our aims in this study were to 1) develop an algorithm that could identify PLWDH in New York State Medicaid data from 2006-2014 and 2) validate this algorithm using the New York State HIV surveillance system. Classification and regression tree analysis identified 16 nodes that we combined to create a case-finding algorithm with 5 criteria. This algorithm identified 86,930 presumed PLWDH, 88.0% of which were verified by matching to the surveillance system. The algorithm yielded a sensitivity of 94.5%, a specificity of 94.4%, a positive predictive value of 88.0%, and a negative predictive value of 97.6%. This validated algorithm has the potential to improve the utility of Medicaid data for assessing health outcomes and programmatic interventions.

Age related medication for addiction treatment (MAT) use for opioid use disorder among Medicaid-insured patients in New York.

BACKGROUND: Medication for addiction treatment (MAT) has received much attention in recent years for treating individuals with opioid use disorders (OUD). However, these medications have been significantly underused among particular subgroups. In this paper, we describe the age distribution of treatment episodes for substance use disorder among Medicaid beneficiaries in New York and corresponding MAT use. METHODS: Using New York Medicaid claims, we identified individuals with OUD that received treatment for substance use disorder in 2015. The type of substance use treatment is the primary outcome measure, which includes methadone, buprenorphine, naltrexone or other non-medication treatment. RESULTS: A total of 88,637 individuals were diagnosed with OUD and received treatment for substance use disorder and 56,926 individuals received some type of MAT in 2015, with 40.2% receiving methadone, 21.9% receiving buprenorphine and 2.2% receiving naltrexone while 21.9% received non-medication based treatment. Young adults (ages 18-29) were a large proportion (25%) of individuals in treatment for OUD yet were the least likely to receive MAT. Relative to young adults, 30-39 year olds (adjusted odds ratio [AOR] = 1.62, 95% CI = 1.56-1.68), 40-49 year olds (AOR = 1.90, 95% CI = 1.82-1.99), 50-59 year olds (AOR = 2.65, 95% CI = 2.52-2.78), and 60-64 year olds (AOR = 5.03, 95% CI = 4.62-5.48) were more likely to receive MAT. CONCLUSIONS: These preliminary findings highlight high numbers of young adults in treatment for OUD and low rates of MAT, which is not consistent with treatment guidelines. Significant differences exist in the type of medication prescribed across age. More attention is needed to address the treatment needs among individuals of different age, notably young adults.

Recurrent use of inpatient withdrawal management services: Characteristics, service use, and cost among Medicaid clients.

Reducing repeat use of costly inpatient services, such as inpatient withdrawal management, among Medicaid members is a target of healthcare reform. However, characteristics of frequent users of inpatient withdrawal management are understudied. We described the characteristics, service utilization, and costs of New York Medicaid clients who use withdrawal management services by analyzing data from Medicaid records from 2008. We examined follow-up care for individuals with different levels of repeat withdrawal management. We found 32,196 Medicaid withdrawal management patients with a total of 67,073 episodes and we divided patients into low (1 episode, n = 19,602), medium (2-3 episodes, n = 8619) and high (≥4 episodes, n = 3978) use categories. High users had almost 8 times the withdrawal management cost of low users. Similarly, they had 5 times more emergency department visits than low users. High users had high levels of homelessness (75%), 20% had HIV/AIDS, and 40% had Hepatitis. High withdrawal management users were less likely than low users to receive any follow-up treatment services. Medicaid clients with high utilization of inpatient withdrawal management are a small but costly population with poor follow-up rates to subsequent treatment services. They are a socially disenfranchised group that may benefit from targeted services to address their complex clinical needs.

Medicaid care management: description of high-cost addictions treatment clients.

High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals <90th percentile of AODTx expenditures (n=41,054); high-cost clients in the top decile of AODTx expenditures (HC; n=5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals.

Health behaviors of older Chinese adults living in New York City.

The dramatic increase in the number of older immigrants living in the U.S. presents new challenges to policy makers concerned with promoting healthy aging. To date, however, strikingly little is known regarding the health and health trajectories of older immigrants. This paper examines the prevalence and predictors of important health behaviors associated with chronic disease prevention, including current smoking status, physical activity, alcohol use, and body mass index (BMI). We analyzed data from the 2003 New York City Chinese Health Survey (NYC CHS), the largest probability-based sample of Chinese immigrants residing in two distinct communities. In-person interviews were conducted with 517 representative men and women aged 55-75. Logistic regression modeling was used to test the influence of demographic, socioeconomic status, acculturation, and health characteristics on selected health behaviors. Results revealed that having more education and better physical health status were associated with greater participation in physical activity. Gender-specific analyses indicated that the effect of selected predictors varied between the sexes. For example, among older Chinese women, acculturation was negatively associated with alcohol use. This study provides some of the first evidence on health behaviors of one of the fastest growing older immigrant groups in the U.S. Study results add to the emerging literature on the complex nature of immigrant health trajectories, and demonstrate that contrary to prior research, living a greater proportion of time in the U.S. can be associated with selected positive health behaviors. Further longitudinal studies are needed to help inform policy initiatives to encourage healthy aging among diverse older immigrant groups.

Body weight and length of residence in the US among Chinese Americans.

BACKGROUND: It has been shown that as immigrants' length of residence increases, so does their weight. However, little is known about factors associated with weight status among Chinese Americans, one of the fastest growing immigrant populations in the US. METHODS: Baseline data from a National Cancer Institute-funded longitudinal study involving a multi-stage probability sample of Chinese Americans residing in two communities in New York City were collected. RESULTS: Chinese Americans had a low BMI (mean = 22.81) and a lower proportion of obese individuals compared with other ethnic groups in the US reported in the literature. While the prevalence of being overweight (21%) and obese (2%) was low, length of residence was positively associated with weight status (P < 0.005). CONCLUSIONS: Innovative strategies to help Chinese Americans maintain healthy weight status and to prevent them from becoming overweight and obese are needed.

Effectiveness of tobacco control among Chinese Americans: a comparative analysis of policy approaches versus community-based programs.

OBJECTIVE: To estimate the effectiveness of a tailored multicomponent community-based smoking cessation intervention among Chinese immigrants living in New York City, implemented within the context of state and city-wide tobacco control policy initiatives for the general population. METHODS: A pre-post-test quasi-experimental design with representative samples from Chinese populations living in two communities in New York City: Flushing, Queens, the intervention community and Sunset Park, Brooklyn, the comparison community. From November 2002 to August 2003 baseline interviews were conducted with 2537 adults aged 18-74. In early 2006, 1384 participants from the original cohort completed the follow-up interview. During the intervention period (October 2003 to September 2005), both communities were exposed to tobacco control public policy changes. However, only Flushing received additional linguistically and culturally-specific community-level tobacco control interventions. RESULTS: From 2002 to 2006 overall smoking prevalence among Chinese immigrants declined from 17.7% to 13.6%, a relative 23% decrease. After controlling for socio-demographic characteristics, there was an absolute 3.3% decrease in smoking prevalence attributed to policy changes with an additional absolute decline in prevalence of 2.8% in the intervention community relative to the control community. CONCLUSION: City-wide tobacco control policies are effective among high-risk urban communities, such as Chinese immigrants. In addition, community-based tailored tobacco control interventions may increase the reduction in smoking prevalence rates beyond that achieved from public policies.

Tobacco use behaviors and household smoking bans among Chinese Americans.

PURPOSE: To assess the relationship between household smoking restrictions and smoking patterns among Chinese American adults. DESIGN: This is a cross-sectional analysis based on a National Institutes of Health-funded population-based household and telephone survey of 2537 Chinese American adults. SETTING: Two communities in New York City. SUBJECTS: The analyses focused on male current smokers (N = 600). MEASURES: Demographic characteristics, smoking status, household smoking restrictions, cigarettes smoked per day, and past quit attempts were based on self-reported data. RESULTS: Among current smokers, 37% reported living in a home with a complete smoking ban. Smokers with a full household smoking ban smoked fewer cigarettes on weekdays and weekends than smokers with no household smoking ban (p < or = .05) and were 3.4 times (p < .01) more likely to report having at least one quit attempt in the past 12 months. Smokers with knowledge of the dangers of environmental tobacco smoke (ETS) exposure were 2.8 times (p < or = .01) more likely to have at least one quit attempt in the last 12 months compared with those who were unaware of the danger of ETS and more likely to live in a smoke-free household. CONCLUSIONS: Smoke-free home policies and interventions to raise awareness among smokers of the dangers of ETS have the potential to significantly reduce tobacco use and exposure to household ETS among this immigrant population.

The relative effect of household and workplace smoking restriction on health status among Chinese Americans living in New York City.

Households and workplaces are the predominant location for exposure to secondhand smoke. The purpose of this study is to examine the association between health status and smoking restrictions at home and work and to compare the relative effect of household and workplace smoking restrictions on health status. This study uses data from a cross sectional representative probability sample of 2,537 Chinese American adults aged 18-74 living in New York City. The analysis was limited to 1,472 respondents who work indoors for wages. Forty-three percent of respondents reported a total smoking ban at home and the workplace, 20% at work only, 22% home only, and 15% reported no smoking restriction at home or work. Nonsmokers [corrected] who live under a total household smoking ban only or both a total household and total workplace ban were respectively 1.90 and 2.61 times more likely to report better health status compared with those who reported no smoking ban at work or home. Before the NYC Clean Indoor Air Act second-hand smoke (SHS) exposure among this immigrant Chinese population at home and work was high. This study finds that household smoking restrictions are more strongly associated with better health status than workplace smoking restrictions. However, better health status was most strongly associated with both a ban at work and home. Public health efforts should include a focus on promoting total household smoking bans to reduce the well-documented health risks of SHS exposure.

Correlates of household smoking bans among Chinese Americans.

No population-based data are available on the degree to which Chinese Americans have adopted smoke-free household policies and whether these policies are effective in reducing environmental tobacco smoke (ETS) exposure. The present study examines the prevalence of smoke-free home rules among Chinese Americans living in New York City, describes predictors of adopting full smoking bans in the home, and explores the association between household smoking restrictions and ETS exposure at home. In-person interviews using a comprehensive household-based survey were conducted with 2,537 adults aged 18-74 years. Interviews were conducted in Mandarin, Cantonese, and other Chinese dialects. A total of 66% of respondents reported that smoking was not allowed inside the home, 22% reported a partial ban on smoking in the home, and 12% reported no smoking ban. Among current smokers, 38% reported a full household smoking ban. Current smoking status was the strongest predictor of less restrictive household smoking policies. Knowledge of the dangers of ETS, support of smoke-free air legislation, years in the United States, gender, income, and marital status also were associated with household smoking bans. Those living with a total household smoking ban were significantly less likely to report 30-day exposure to ETS than were those living in homes with a partial ban or no ban (7% vs. 68% and 73%, respectively). In homes of smokers and nonsmokers alike, exposure to ETS remains high. Smoke-free home rules and interventions among smokers and nonsmokers to raise awareness of the dangers of ETS have the potential to significantly reduce exposure to household ETS among this immigrant population.