Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 20, Issue 4, 2017. Pages: 167-175
Published Online: 1 December 2017

Do High Fidelity Wraparound Services for Youth with Serious Emotional Disturbances Save Money in the Long-Term?

Angela Snyder,¹ James Marton,² Susan McLaren,³ Bo Feng,⁴ Mei Zhou⁵

¹PhD, MPH,* Research Associate Professor, Georgia Health Policy Center and Department of Public Management and Policy, Georgia State University, Atlanta, GA, USA
²PhD, Associate Professor, Department of Economics, Georgia State University, Atlanta, GA, USA
³MPH, Senior Research Associate, Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
⁴MPA, PhD Candidate, Department of Public Management and Policy, Georgia State University, Atlanta, GA, USA
⁵MS, Senior Research Associate, Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA

* Correspondence to: Angela Snyder, Georgia Health Policy Center, 55 Park Place, 8th floor, Atlanta, GA 30303, USA.
Tel.: +1-404-413 0285
Fax: +1-404-413 0316
E-mail: angiesnyder@gsu.edu

Source of Funding: This paper was developed under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services as a sub-award to Georgia State University via the Georgia Deparment of Behavioral Health and Developmental Disabilities. However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and one should not assume endorsement by the Federal Government.

Abstract

High Fidelity Wraparound (Wrap) is an evidence-informed practice that sustains community-based placements for youth with serious emotional disturbances through the use of intensive care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence of the benefits, few studies have examined health care spending associated with Wrap participation. When overall health care spending and changes in spending for youth who transitioned from institutional care into Wrap and youth starting institutional care at the same time, but not receiving Wrap are compared, findings suggest that youth participating in Wrap had much higher average monthly baseline costs. Wrap participation reduced monthly health care spending by an additional $1,130 in the post-period, as compared to controls. This was a result of decreases in mental health inpatient spending and general outpatient spending. Further analysis is needed to assess how these spending changes impacted health outcomes.

Background: Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework.

Aims of Study: (i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation.

Methods: The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts.

Results: In the year before Wrap participation, the treatment group averaged $8,433 in monthly health care spending versus $4,599 for the control group. Wrap participation led to an additional reduction of $1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending.

Discussion: Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed to assess how these spending changes impacted health outcomes.

Implications for Health Policies: Wrap or similar programs may lead to reductions in health care spending. This is the first study to find evidence of longer-term spending reductions for up to a year after Wrap participation.

Implications for Further Research: Randomized trials or some other source of plausibly exogenous variation in Wrap participation is needed to further assess the causal impact of Wrap on health care spending, outcomes, or broader system-of-care spending.

Received 30 December 2016; accepted 6 November 2017