Big Gap In Access To Treatment Post Hospitalization

If Tennessee is anything like a snapshot of the US, we have our work cut out for us to address significant gaps in care in the days and weeks after people with substance use disorders are diagnosed and those with a serious mental health condition are hospitalized:

Case in point, less than 40% of Hispanic and Black Medicaid members took antidepressants and remained on them as directed for at least 6 months after a major depression diagnosis, compared to nearly two thirds of Asian and White commercial members, according to Andrea Willis, MD, chief medical officer for BCBS Tennessee’s 3.3 million members. The insurer has studied its members behaviors and not just where in the great state of Tennessee there are gaps in care or undertreatment, but for whom….

Only about one third of the Medicaid beneficiaries who were hospitalized for intentional self-harm or a mental illness got follow up care within 7 days after discharge.

The insurer specifically measured the behaviors of members age 6+ who were hospitalized for mental illness (such as bipolar disorder) or intentional self-harm and who needed follow-up care with a mental health provider within 7 days of discharge.

On average overall, 38.93% of eligible commercially insured members followed this care plan vs. 42% of Medicaid members.

For substance use disorder, the numbers are much more stark: just 17% of commercially insured members and 19% of Medicaid beneficiaries ages 13+ who were diagnosed with substance use disorder (alcohol, opioid, or other drug) engaged with SUD treatment care within a month of diagnosis. The insurer points out that some members are simply unable to access this type of care based on range of factors, but they were excluded from the analysis. The numbers are even lower (12%) for Black and (16%) for Hispanic Medicaid members covered by the insurance.

This suggests a MAJOR problem persists with transitions continues from hospital to care.

Source: BCBS of Tennessee