NASHVILLE, Tenn. ñ TennCare provided behavioral health services to more of the state’s children during state fiscal years 1994-2000; however, the volume of services children received for emotional and behavioral problems decreased, a new study shows.
"While TennCare made great strides in serving more children during a period when youth enrollees in the program increased, it was basically a case of redistribution ñ giving existing children in the program less volume of services and using the savings to spread services across more children," said Robert Saunders, lead author of the study and research associate in the Department of Human and Organizational Development at Vanderbilt University.
"There was a shift away from expensive services; for example, a decline in the use of inpatient care in favor of less expensive outpatient care and community services," Saunders said.
The study is the first comprehensive snapshot of statewide trends in access to and use of behavioral health care services for school-aged children based on TennCare-provided data. Saunders with Craig Anne Heflinger,
Vanderbilt associate professor of Human and Organizational Development, looked at claims, encounter and enrollment data for children and adolescents aged 4 to 17 during state fiscal years 1994-2000.
The results of the study appear in the October edition of Psychiatric Services, a journal of the American Psychiatric Association. Grants from the Center for Substance Abuse Treatment, National Institute on Drug Abuse and the National Institute for Alcoholism and Alcohol Abuse funded the report.
The researchers evaluated performance measures in four areas ñ overall access to behavioral health services, use of inpatient services, use of outpatient specialty treatment services and use of supportive services like case management and medication management.
What they found is that children’s access rates for behavioral health services improved even as the TennCare program expanded to cover more children. The number of youths who received a behavioral service increased by nearly 50 percent ñ from 29,169 to 43,825 ñ between state fiscal years 1995 and 2000. At the same time youths enrolled in TennCare increased by 19 percent ñ from 401,403 to 477,714.
The annual access rate increased from 72.7 youths per 1,000 enrollees to 91.7. However, access rates were low relative to estimates of need in school-aged children, according to the report.
"TennCare may be a victim of its own success. Although the number of children served increased during the study period, the program greatly reduced the volume of care children received for emotional and behavioral problems. This raises issues of quality of care that need further exploration," Heflinger said.
The extraordinary increase in the number of people served by TennCare has made the program more costly than anticipated, the researchers write. Until July 2002 Tennessee was among the states with the lowest level of uninsured children. However, recent changes in the TennCare waiver program have resulted in the disenrollment of a large number of children.
Saunders and Heflinger have not explored the potential consequences of the reduction of services for affected children nor the decision-making behind the state’s strategies for dealing with the increase in youth enrollees into the TennCare program.
However, they say, public reports such as this one combined with efforts by the state and managed care companies to measure performance are important first steps on the road to ongoing and cooperative evaluation of the behavioral health service delivery system for children in Tennessee.
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