title: Cost savings from assertive community treatment services in an era of declining psychiatric inpatient use.
abstract: OBJECTIVE
  To assess, during a period of decreasing psychiatric inpatient utilization, cost savings from Assertive Community Treatment (ACT) programs for individuals with severe mental illnesses.
  
  
  METHODS
  U.S. Department of Veterans Affairs' (VA) national administrative data for entrants into ACT programs.
  
  
  METHODS
  An observational study of the effects of ACT enrollment on mental health inpatient utilization and costs in the first 12 months following enrollment. ACT enrollees (N = 2010) were propensity score matched to ACT-eligible non-enrollees (N = 4020). An instrumental variables generalized linear regression approach was used to estimate enrollment effects.
  
  
  RESULTS
  Instrumental variables estimates indicate that between FY2001 and FY2004, entry into ACT resulted in a net increase of $4529 in VA costs. Trends in inpatient use among ACT program entrants suggest this effect remained stable after FY2004. However, eligibility for ACT declined 37 percent, because fewer patients met an eligibility standard based on high prior psychiatric inpatient use.
  
  
  CONCLUSIONS
  Savings from ACT programs depend on new enrollees' intensity of psychiatric inpatient utilization prior to entering the ACT program. Although a program eligibility standard based on prior psychiatric inpatient use helped to sustain the savings from VA ACT programs, over time, it also resulted in an unintended narrowing of program eligibility.
authors.affiliation: Capitol Healthcare, Network (VISN 5) Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs, Baltimore, MD 21201, USA. eslade@psych.umaryland.edu
authors.forename: Eric P
authors.initials: EP
authors.lastname: Slade
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: Stephanie
authors.initials: S
authors.lastname: Visnic
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Dixon
mesh_terms: D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration*; D017046:Cost Savings; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000458:organization & administration*