1. Introduction

This study seeks to bridge the gap in the quantitative workforce research on Medicaid patients with schizophrenia. It is an important first step in a larger program of research to identify the temporal and geographic need and access to Medicaid patients with schizophrenia for the workforce with a focus on individuals who provide direct behavioral health services and population health services across the entire workforce spectrum. The findings of workforce will facilitate future research to address the potential disparities on outcome and quality of care over time for Medicaid patients with schizophrenia. While there are evidence that Medicaid patients with schizophrenia are not receiving appropriate care for various reasons of both patient and workforce, ranging from ineffective coordination among service providers, insufficient or lack of providers, stigma and racial type, research on geographic need and distribution of the workforce to serve Medicaid patients with schizophrenia is critical to inform the development of a rational system for achieving access to effective and efficient care. Such knowledge is essential to developing a model to understand how the geographic variability of the workforce influence access to care for Medicaid patients with schizophrenia. In addition, research focusing on the distribution of providers by specialty will help to identify and assess the effect of potential area service perturbations on community care. This includes changes in the physical environment of services, changes in patient and their social net movement with special consideration of the effect of permanent professionals who either move or stop working in certain areas. Also, such as analysis will help to evaluate the impact of the development and implementation of novel treatment and diagnostic techniques which focus on certain type of providers. Currently most economic, outcome and evaluation research and study proposals has ignored the dynamic natures, both geographically and temporally, of the mental health workforce and the effect on the patients, the health care condition, the providers themselves and others. However such information is critical for cost-effective allocation of resources, development of interventions strategies, treatment management and public policymaking. From the policy prospective, this study is particularly ‘well tailored’ to the recent federal and state regulations on the parity for mental health and substance abuse services. The regulation needs plans to use generally accepted standards of care that ultimately require the health insurer to provide consistent care, regardless of whether the intervention would be classified as either a medical or as behavioral one. The discovery of the bureaucratic clusters would potentially democracy the stakeholders to request the state government to change the boundary of required health planning area since Medicaid patients with schizophrenia are living in such area had significant clinical characterized cluster well defined by the workforce detectability profile. Such a better sense of ‘physiological ground’ for Medicaid patients with schizophrenia for a certain area will facilitate the delivery of community care while preserving the access to specialized effective treatment.

1.1. Background

In 1963, the United States Congress passed the Community Mental Health Act, forming the deinstitutionalization process and the progressive closure of state psychiatric hospitals. Many patients with severe mental illnesses, including those with schizophrenia, were released into the community with the hope of receiving treatment and support from community-based providers. Despite increasing efforts to make behavioral health services more available, the treatment gap persists, and access to care has remained a challenge for many people with schizophrenia. This is particularly true for those individuals who rely on Medicaid, a federal and state funded program that provides health coverage to people with low income, including adults with serious mental illnesses. As the largest provider in the United States, Medicaid plays a critical role in supporting individuals with schizophrenia. However, there is a lack of accurate and timely information on the types and the distribution of behavioral health providers who serve this population. Previous research using data from the Centers for Medicare and Medicaid Services (CMS) claims data has been successful in depicting the workforce situation for Medicare beneficiaries. However, there is a need for similar studies focusing on Medicaid patients with schizophrenia, given that each Medicaid program differs in terms of covered services and eligibility criteria, and state variations in providers’ participation status and reimbursement rates. In this research, we work to fill the knowledge gap by using Medicaid claims data to identify and analyze the behavioral health workforce for patients with schizophrenia. Using South Carolina as the study state, this research sets out to accomplish three specific aims. First, we aim to construct a person-level cohort of Medicaid patients with schizophrenia in South Carolina. Next, we intend to utilize claims data to identify the types of behavioral health services utilized by Medicaid patients with schizophrenia. Lastly, we seek to geographically map and analyze the distribution of different provider types by specialty. The results of this research will provide useful information for policymakers, health service researchers, and delivery systems to better understand strategies for addressing the workforce shortage in the specialty of schizophrenia and to improve the delivery of services for the Medicaid population.

1.2. Purpose

This is the second major purpose of the study. This purpose is related to the first one, but it focuses on workforce specialty distribution, which is not mentioned in the first purpose. Another reason why the author carries out the study is that the author wants to improve the methods of identifying the workforce from the existing studies. He mentioned that “these methods can inform workforce policy” and “comparative data analysis” for different areas of the country. This sentence provides a third reason for the research. So there are three major reasons for the study in the purposes section. And based on this purpose, I think the author is going to use some new methods to compare with the existing method, and this study would be a guidance for policy makers according to what the author is saying in the introduction part.

2. Methodology

2.1. Data collection

2.2. Data analysis

3. Results

3.1. Number of Medicaid patients with schizophrenia

3.2. Types of behavioral health services utilized

3.3. Provider distribution by specialty

4. Discussion

4.1. Implications of the findings

4.2. Challenges in accessing behavioral health services

4.3. Recommendations for improving workforce availability

5. Limitations

5.1. Data limitations

5.2. Generalizability of findings

6. Conclusion

7. References

Identifying the behavioral health workforce for Medicaid patients with schizophrenia using claims data

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