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A study in this week's New England Journal of Medicine reviewed the consequences of switching patients on antipsychotic medications to a 'carve out' medicaid privitization of mental health services. Patients served by the HMOs in Tennessee were 1.18 times more likely to miss at least 60 days of treatment, including medication, during follow-up after initial treatment. High-risk patients were especially likely to miss treatment after the changeover. Nearly 30 percent of them weren't treated for 60 days or more, compared to 20.3 percent of those studied in the pre-HMO period.
Researchers point out that "this difference was most pronounced among high-risk patients (those requiring the administration of extended-release [depot] injections of antipsychotic medications or who had been hospitalized for psychosis) at base line, for whom continuity was most important with a mean reduction in the number of days of antipsychotic therapy of 14.4 days. These patients had decreased use of antipsychotic drugs immediately after the transition; the lower level persisted throughout the 12 months of follow-up."
This study was conducted by Vanderbult researchers and studied the HMO system in Tennessee. An accompanying commentary in NEJM mentions that other states did a better job of switching patients to private care but apparently in this study, all of the carefully developed strategies to help patients adhere to their medications (e.g.ancillary services, reminders, transportation, etc) were lost under the new program.
There are many lessons to be learned and untold repercussions beyond the statistics.
11:19:43 PM 
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