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The Influence of Integration on the Expenditures and Costs of Mental Health and Substance Use Care: Results from the Randomized PRISM-E Study

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Abstract

We compared the healthcare costs associated with an integrated care model to an enhanced referral model for the treatment of depression, anxiety, and at-risk drinking from the randomized Primary Care Research in Substance Abuse and Mental Health for the Elderly study. We examined total healthcare costs and cost components, separately for Veterans Affairs (VA) and non-VA participants. No differences in total health expenditures were detected between study arms. No differences in behavioral health expenditures were detected for non-VA sites, but the VA integrated arm had slightly higher ($38; p < 0.05) behavioral health costs. Differences in other types of services use were detected.

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Authors and Affiliations

  1. The University of North Carolina School of Public Health, 1104G McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA

    M. E. Domino

  2. JSI Research and Training Institute, Inc., 44 Farnsworth Street, Boston, MA, 02210, USA

    J. Maxwell, S. Grantham & S. Zaman

  3. VA Office of Research & Development, Department of Veterans Affairs, 810 Vermont Ave., NW (12), Washington, DC, 20420, USA

    M. Cody

  4. Brigham and Women’s Hospital, 1249 Boylston Street, 3rd Floor, Boston, MA, 02215, USA

    K. Cheal

  5. Departments of Psychiatry and Health Care Policy, Harvard Medical School, McLean Hospital, Alcohol and Drug Abuse Treatment Program, Proctor 305, 115 Mill St., Belmont, MA, 02478, USA

    A. B. Busch

  6. Office of Mental Health Services, Department of Veterans Affairs, 810 Vermont Ave., NW (116A), Washington, DC, 20420, USA

    W. W. Van Stone

  7. Office of Geriatrics and Extended Care, Department of Veterans Affairs, 810 Vermont Ave., NW, Washington, DC, 20420, USA

    S. G. Cooley

  8. Managed Care Initiatives, University of Pennyslvania, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA

    C. Zubtritsky

  9. Institute for Health and Aging, University of California, San Francisco, 3333 California St., Suite 340, San Francisco, CA, 94118, USA

    C. L. Estes

  10. Center for Healthcare Knowledge Management, VA East Orange Medical Center, VA New Jersey Healthcare System, 385 Tremont Avenue, 129, East Orange, NJ, 07018, USA

    Y. Shen

  11. LifeLong Medical Care, P.O. Box 11247, Berkeley, CA, 94712-2247, USA

    M. Lynch

  12. Division of State and Community System Development, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services, 5600 Fishers Lane, Room 15C-18, Rockville, MD, 20857, USA

    P. Wohlford

  13. Indian Health Service, Office of Clinical & Preventive Service, Division of Nursing, Health Resources Services Administration, 801 East Thompson Ave., Rockville, MD, 20852, USA

    M. C. Aoyama

  14. Department of Psychiatry and Behavioral Health Services, Lutheran HealthCare, 15055th St., Brooklyn, NY, 11220, USA

    J. Fitzpatrick

  15. Department of Medicine, Columbia University Medical Center, 622 W. 168th Street, VC-205, New York, NY, 10032, USA

    J. Dodson

  16. Brigham and Women’s Hospital and Harvard Medical School, 1249 Boyston Street, 3rd Floor, Boston, MA, 02210, USA

    S. E. Levkoff

Authors
  1. M. E. Domino
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  2. J. Maxwell
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  3. M. Cody
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  4. K. Cheal
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  5. A. B. Busch
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  6. W. W. Van Stone
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  7. S. G. Cooley
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  8. C. Zubtritsky
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  9. C. L. Estes
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  10. Y. Shen
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  11. M. Lynch
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  12. S. Grantham
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  13. P. Wohlford
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  14. M. C. Aoyama
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  15. J. Fitzpatrick
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  16. S. Zaman
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  17. J. Dodson
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  18. S. E. Levkoff
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Corresponding author

Correspondence to M. E. Domino.

Additional information

PRISM-E is a collaborative research study funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), including its three centers: Center for Mental Health Services (CMHS), Center for Substance Abuse Treatment (CSAT), and the Center for Substance Abuse and Prevention (CSAP). The Department of Veterans Affairs (VA), the Health Resources and Services Administration (HRSA), and the Centers for Medicare and Medicaid Services (CMS) provided additional support and funding. Dr. Domino gratefully acknowledges additional support from NIMH (K01 MH 065639).

PRISM-E Study Investigators (in alphabetical order):

Carolyn Aoyama (HRSA), Pat Arean (Co-PI), Stephen Bartels (PI), Hongtu Chen (PI), Henry Chung (Co-PI), Marisue Cody (Co-PI), Susan Cooley (VA), Giuseppe Costantine (PI), U. Nalla B. Durai (PI), Carroll Estes (PI), Jack Fitzpatrick (Co-PI), Brian Goodman (Co-PI), Trevor Hadley (Co-PI), Timothy Howell (Co-PI), Ira Katz (Co-PI), JoAnn Kirchner (PI), Dean Krahn (PI), Sue Levkoff (PI), Karen Linkins (Co-PI), Maria Llorente (PI), Ann Mahony (SAMHSA), James Maxwell (Co-PI), Keith Miles (Co-PI), Robert Molokie (Co-PI), John McIntyre (PI), Elizabeth McDonel Herr (SAMHSA), Michael Nazar (Co-PI), Edwin Olsen (PI), David Oslin (PI), Thomas Oxman (Co-PI), Andrew Pomerantz (Co-PI), Louise Quijano (Co-PI), Patricia Sabry (SAMHSA), Heidi Syropoulos (Co-PI), William Van Stone (VA), Paul Wohlford (SAMHSA), Cynthia Zubritsky (PI)

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Domino, M.E., Maxwell, J., Cody, M. et al. The Influence of Integration on the Expenditures and Costs of Mental Health and Substance Use Care: Results from the Randomized PRISM-E Study. Ageing Int. 32, 108–127 (2008). https://doi.org/10.1007/s12126-008-9010-7

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  • DOI: https://doi.org/10.1007/s12126-008-9010-7

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