Agency For Health Care Administration (AHCA) Reports

Back To AHCA Reports Home

Currently Funded AHCA Projects

The following two projects are being conducted during as part of our FY 2016-17 contract (MED174) with the Florida Agency for Health Care Administration.

• Access, Integration, and Quality of Care for Individuals with Serious Mental Illness in Florida's MMA Program
• Access, integration and service utilization of child welfare involved children enrolled in and outside the Child Welfare Specialty Plan (CWSP)

Assessment of Care Coordination and Health Indicators for Individuals with Serious Mental Illness Enrolled in the Managed Medical Assistance (MMA) Program

Study Purpose and Goals

The purpose of this study is to evaluate how the care coordination activities of Florida’s Managed Medical Assistance (MMA) plans impact the service use and outcomes of children and adults with serious mental illness (SMI). The goals of this project are to: identify the elements of MMA plan care coordination, compare the care coordination process across various MMA plans, and assess the extent to which plan care coordination strategies are associated with the service utilization patterns and physical and behavioral health outcome (e.g., Baker Act initiations) for children and adults with serious mental illnesses. Results will provide the Agency for Health Care Administration (AHCA) with indicators to focus on for performance monitoring with the MMA plans.

Method

Questions related to this project will focus on how various MMA plan care coordination strategies impact SMI enrollees’ physical and behavioral health service utilization and outcomes.

Data collected will focus on answering the following purposed questions:

• Based on the research literature and plan contracts, what are the important elements of care coordination and which of these elements are required and/or offered by MMA plans (comparing the SMI plan to standard plans as a whole and per plan)?
• How is care coordination operationalized by the plans and what are the perceived facilitators/barriers to care coordination (comparing the SMI plan to standard plans as a whole and per plan)?
• To what extent is there an association between the plan rankings with respect to care coordination, services and service use, and health outcomes by enrollees with SMI in these plans?
• What are the perspectives of family members with regards to the effectiveness of plans’ care coordination, including the relative effectiveness of telephone versus in-person care coordination (comparing the SMI plan to standard plans as a whole and per plan)?
• What are the demographic and diagnostic characteristics of individuals who receive low, medium, higher amounts of care coordination services, compared at the plan level?
• What are the aggregate HEDIS measure scores (computed using Medicaid encounter/claims data) for recipients with SMI by plan?
• How do sociodemographic factors influence aggregate HEDIS measure scores (computed using Medicaid encounter/claims data), and what is the relationship between these scores and (a) outcomes, (b) region, and (c) operational structure of the plans?
• How satisfied are family members with plan care coordination processes, including administrative functions and interactions with care coordinators (comparing SMI plan to standard plans as a whole)?

A mixed method approach will be taken in this project. Both qualitative and quantitative methods will be used to evaluate service strategies used by the MMA plans to address the unique needs of individuals with SMI. The project shall begin with an extensive review of the literature to identify and classify the elements of care coordination, such as assessing needs, planning treatment, coordinating visits, organizing care, and sharing information. This information will result in a new framework that will be used to review MMA plan contracts (including supplements and amendments), internal documents related to care coordination, and other similar documents to determine which aspects of care coordination are offered by the plans.

This project will use Medicaid data to select the plans from which interviews with MMA plan administrators will be conducted. Four (4) plans with the highest number of SMI enrollees and two (2) plans with the lowest number of SMI enrollees will be selected for the interviews.

The project will use previous research results in which MMA plans were classified by elements of care coordination supplemented by the findings from the qualitative methods as described above, to determine if service use by enrollees with SMI in each of these plans is associated with these classifications. The project’s analysis will be limited to individuals with SMI (using the most recent Agency-approved algorithm from AHCA’s actuary firm) who are enrolled in the six (6) specified plans identified above, for which differences in demographics and health status will be accounted.

The project will explore the effectiveness of plan care coordination as it relates to physical and behavioral health service utilization (e.g., annual primary care visits, adherence to maintenance medications, utilization of specialty care, utilization of dental care) and health outcomes (e.g., Baker Act initiations, psychiatric and medical inpatient hospitalizations, utilization of emergency rooms, and criminal justice encounters). Patterns of physical and behavioral health services used and outcomes among plans will be compared also. Lastly HEDIS measures at the plan level will be computed for the recipients with SMI who are enrolled in the six (6) plans that were identified during the SFY 15-16 contract period to ensure the project has sufficient sample size in the plans to conduct meaningful analyses. The project will examine the relationship between HEDIS measures and outcomes, determine if there are differences in scores by region or county, and account for any differences in HEDIS measures based on the operational structure of the plans.

Project Team

Mary Armstrong, Ph.D., Principal Investigator Roger Boothroyd, Ph.D., Co-PI Lodi Rohrer, MSPH, Project Director Rene Anderson Areana Cruz, MSEd. John Robst, Ph.D. Gregory Teague, Ph.D.

For additional information about this study please conduct Lodi Rohrer at llrohrer@usf.edu

Pattern of Access, Service Use, and Outcomes for Persons with Substance Use Disorders Across Florida’s Managed Medical Assistance (MMA) Program

Study Purpose and Goals

The purpose of this study is to describe this study is to describe and evaluate the structure of and differences in engagement, access, and utilization of substance use disorder treatment services across Florida’s MMA program. A multi-method approach will be used to examine patterns in utilization and access to care across Florida’s MMA program comparing patterns of use and types of services delivered. Successful care coordination and positive outcomes are especially relevant in two (2) specific subpopulations targeted for in-depth analyses in this evaluation, including pregnant women and young adults (aged 18 to 24). The values of this analysis to the Agency for Health Care Administration is in determining the following: who is presenting for care, what services are rendered and whether gaps in care can be identified, whether treatment efforts are achieving desired outcomes, what kinds of services are delivered to special subpopulations of interest; and consumer perceptions as to the services and supports that have been the most impactful in achieving by their experience.

Data collected will focus on answering the following purposed questions:

• What are the characteristics of persons receiving substance use services within the MMA program? Analyses will review the characteristics of those receiving substance use (SU) services, across plans, whether the population is stable or changing and interpret the implications of these changes, if found.
• Does the amount and type of service being delivered vary across the state and across MMA plans? Analyses will evaluate whether patterns of services are evolving and offer interpretation.
• What are typical retention times across levels of care and plans? Analyses will examine differences in retention, completion, and readmission across plans.
• What are the patterns of outcomes, in terms of criminal justice involvement and Baker/Marchman Act admissions, observed in those with substance use disorders? Are reductions in adverse outcomes associated with types of or length in care? Analysis will examine outcomes(s) for those engaged in care across multiple domains.
• Subpopulation Analysis: What do pregnant women (pregnant upon admission or during the course of their care) report on their experience of service across, care integration and quality, and outcomes as they move through care? What treatment elements are perceived as the most impactful? What degree of care coordination occurred across their pregnancy? How do their symptom patterns and treatment need change over the course of their pregnancy?
• Subpopulation Analysis: What do young adults (aged 18 to 24) report on their experience of service access, care integration and quality, and outcomes as they move through care? What treatment elements are perceived as the more impactful? What degree of care coordination occurred across their mental health and physical health providers, if applicable? How have their symptom pattern and treatment needs change over time, from their perspective?

Method

Multiple Methods will be used in this project to address the research questions outlined above. The first four (4) questions will rely on variables available in the administrative data. The sample parameters for the administrative data analysis will focus on adults, 18 to 64 years of age with a substance use disorder (SUD) diagnosis and/or who received substance use treatment services after July 1, 2014. Subpopulation analyses will use a different age ranges, as appropriate. Trends in the rates of diagnoses and services received (including Baker Act and Marchman Act related service contact, when identifiable), criminal justice contacts, and mental/medical health related events will be evaluated. The project will make use of descriptive, univariate, and multivariate statistics to evaluate patterns in services. The project’s analysis of the research questions shall primarily rely on secondary analysis of existing Medicaid claims an encounter data provided to FMHI-PSRCDC by the Agency for Health Care Administration.

The project evaluation of the two (2) subpopulations identified for the last two (2) research questions will involve both quantitative and qualitative analyses. Substance treatment agencies who serve a substantial number of persons funded through Medicaid will be identified and solicited by the project for engagement in this project; and will be compensated for their site coordination efforts in reviewing the research methods, making their treatment populations available to the researchers, and proving onsite office space available for the individual interviews and data collection from the project subjects. A maple size of sixty (60) pregnant women (aged 18-44) and sixty (60) male/female young adults (ages 18-24) will be solicited by the project for their participation. A minimum of three (3) to a maximum of eight (8) treatment sites shall be engaged to participate by the project I order to achieve the proposed sample size.

Members of the project’s research team will engage the participation of adult clients (referred to as key informants) at the treatment sites and will determine whether their service has been funded by Medicaid. The project’s interview and survey content will be developed by reviewing the relevant empirical literature, and will be approve prior by the Agency for Health Care Administration. Interviews will be voice-recorded with the permission of the participant, and transcribed by the projects research assistant. Content Analysis will require careful consideration of data to link codes with words or passages with the text in order to explore overarching themes and/or patterns, to be formulated and reviewed by the Principal Investigator (PI) and Co- Principal (Co-PI).

Project Team

Holly Hills, Ph.D., Principal Investigator Tara Richards, Ph.D., Co-Investigator Charles Dion. M.S.

For additional information about this study please conduct Holly Hills at hills@usf.edu