Over One-Third of Hospitalization Costs in Low-Income Communities Associated with Behavioral Health

Poverty, behavioral health issues, and poor ambulatory care contributed to more than a third of hospitalization costs in 13 low-income N.J. communities, amounting to $880 million in annual inpatient costs, according to a new Rutgers study.

Mental health disorders and substance use were chief among the behavioral health conditions cited, one or more of which were found among 75 percent of high utilizers — patients with at least four hospital stays between 2008 and 2011. Just 32 percent of less frequent users were diagnosed with one or more behavioral health conditions, acording to the report by the Rutgers Center for State Health Policy (CSHP).

In addition to hospitalizations of high users, the study also looked at how preventable hospital admissions could have been avoided with high-quality ambulatory care in the community; for example, hospitalizations caused by uncontrolled diabetes. It found that 40 percent of preventable inpatient hospitalizations were associated with behavioral health conditions.

Researchers found that the integration of physical and behavioral health services, particularly for high utilizers, would result in better care for these high-cost patients, decrease avoidable hospitalizations, and lead to substantial savings in costs. Improved physician-patient communication and high-quality ambulatory care in the community can reduce avoidable and costly hospitalizations, they added.

Although the study focused on hospital data in the 13 communities, the data and findings reflect populations throughout the state, including patients with Medicare, Medicaid, and commercial insurance, as well as the uninsured. Along with the Medicaid population, behavioral health issues were significantly present among patients with other sources of insurance. Therefore, the findings can guide the efforts of policymakers, insurers, and delivery systems in general, not just those specific to Medicaid, researchers note.

The findings are based on analysis of New Jersey’s uniform billing hospital discharge data from 2008-2011, available from the state Department of Health (DOH). Working with the DOH, researchers created a data set that enabled them to follow patient utilization over time. The study population included hospitalizations of all adults (age 18 and over) living in one of 13 low-income communities in New Jersey: Asbury Park, Atlantic City, Camden, Elizabeth, Jersey City, New Brunswick, Newark, Paterson, Perth Amboy, Plainfield, Trenton, Union City, and Vineland. In some cases, neighboring towns also were included.

Source: Rutgers , November 18, 2014

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