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Psych Congress  

Quality Indicators Among Dually Eligible Medicare-Medicaid Patients With Schizophrenia

Janice Lopez, PharmD, MPH
Kate Lapane, PhD
Carmela Benson, MS
Darlene O'Connor, PhD
Brian Quilliam, PhD
Daniel Gilden, MS
Janssen Scientific Affairs, LLC

Background: Dually eligible Medicare and Medicaid enrollees (MMEs) have generally more complex needs compared with Medicare-only counterparts, but quality of care differences for patients with schizophrenia are unclear.

Objectives: Characterize quality indicator (QI) achievement for MME and Medicare-only patients with schizophrenia.

Methods: Retrospective claims analysis used eligibility and claims data from Medicare's 5% 2012 limited dataset. Adults with ≥ 1 inpatient or ≥2 outpatient claims with a schizophrenia diagnosis (ICD-9CM 295, excluding 295.7) with fee-for-service MME or Medicare-only status throughout 2012 were eligible (n=11,456). 2012 Schizophrenia and diabetes-related HEDIS (QIs) were compared. Resource utilization rates described as per 1000 persons.

Results: 8,635 MME and 2,821 Medicare-only were identified. A higher percentage of MMEs were <65 years old (81.1%) than Medicare-only patients (70.7%), but appeared similar in depression, substance abuse, diabetes, and heart disease prevalence. MMEs had more psychiatric hospital admissions (189/1,000) and ER visits (415/1,000) than the Medicare-only group (129/1,000 and 331/1,000). Rates of rehospitalization (7-day: 6.7% MME, 5.6% Medicare-only; 30 day: 21.6% MME, 20.1% Medicare-only) and post-discharge follow-up appeared similar between MME and Medicare-only (7-day: 35.0% MME, 34.6% Medicare only; 30 day: 59.3% MME, 56.4% Medicare only). Adherence to diabetes-related screening QIs protocols was low (A1C: 22.3% MME, 18.4% Medicare only; eye exam: 12.8% MME, 9.9% Medicare only; 7.4% neuropathy exam: MME, 7.2% Medicare only).

Conclusions: QIs for patients with schizophrenia appear suboptimal, but comparable, and possibly better, among MMEs versus Medicare-only patients. Further research is warranted to understand why MMEs have greater utilization with similar disease prevalence and QIs.

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