0. Impact of Early Intervention Programs for Persons with Potentially Disabling Conditions: Evidence from the National DMIE Evaluation
American Public Health Association Annual Meeting
Denver, Colorado
November 10, 2010
Boyd Gilman ● Gilbert Gimm ● Henry Ireys ●
Noelle Denny-Brown ● Sarah Croake

1. Presenter Disclosures
Boyd Gilman
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose

2. Purpose of DMIE Evaluation
To determine whether the provision of early intervention services to working adults with potentially disabling medical or mental health conditions can help prevent or delay loss of work and transition to disability

3. DMIE Eligibility Between 18 and 64 years
Working at least 40 hours per month
Not receiving or applying for federal disability benefits

4. DMIE Target Populations
Target Conditions
Target Population
Hawaii
Diabetes
Employer-sponsored plans
Kansas
Medical and mental health conditions
State high-risk insurance pool
Minnesota
Severe mental illness
State-funded plans for low-income uninsured
Texas
Severe mental illness or behavioral health diagnoses with physical impairment
County-based plan for low-income uninsured

5. DMIE Benefits
Medicaid-like and enhanced medical, behavioral, dental services
Employment training and support services
Client-centered case management and navigation services
Financial assistance with premiums and copayments, or elimination of annual spending limits

6. Evaluation Design Randomized assignment Intent-to-treat analysis
Treatment group (offered early intervention services)
Control group (“business as usual”)
Intent-to-treat analysis
Regression-adjusted impact estimates
Controlling for participant age, health status, withdrawals, and enrollment year, plus prior applications, baseline employment status, or baseline hours worked
Estimates based on Round 2 survey data weighted to account for nonresponse
Data pooled across two states with similar target populations

7. Data Sources
Uniform state survey data (baseline and 12- month follow up) on:
Demographic characteristics
Physical and mental health characteristics
Employment characteristics
Federal SSA administrative data
831 file on disability applications
Master earnings file (derived from W-2 reports)

8. DMIE Enrollment Treatment Control Total Hawaii Kansas 225 275 500
124 60
184
Kansas
225
275
500
Minnesota
888
267
1,155
Texas
886
695
1,581
Counts based on DMIE participants with SSNs that were verified and approved by SSA.

9. Baseline Demographic Characteristics
Hawaii
Kansas
Minnesota
Texas
Age (mean years)
48.4
50.7
38.5
47.0
% Female
61.4
50.6
60.8
76.3
% Currently married
52.2
54.6
23.3
24.7
% White and non-Hispanic
17.4
96.0
81.9
% 4-year college graduate
50.5
44.4
19.8
8.4
Avg. number of conditions
1.0
3.7
1.6
4.9

10. Baseline Employment Characteristics
Hawaii
Kansas
Minnesota
Texas
Average monthly hours worked
154.2
148.4
120.8
119.4
% Working at least half time
94.6
82.2
75.6
73.0
% Working full time
54.9
49.0
21.9
31.2
2008 earnings (mean dollars)
$49,714
$33,874
$17,391
$15,316
2008 earnings as % federal poverty level
478.0
325.7
167.2
147.3

11. Impact on Federal Disability Applications within 1 Year of Enrollment
Percent Submitting Application in Treatment
Percent Submitting Application in Control
Difference (Impact)*
P-value
Two States
4.8
6.9
-2.1
.03
Minnesota
3.6
6.2
-2.6
.06
Texas
5.8
7.6
-1.8
.15
Kansas
0.3
0.8
-0.5
.47
Hawaii
0.0 --
* Regression-adjusted impact estimates. Two states in first row are Minnesota and Texas.

12. Percent Not Working in Treatment Percent Not Working in Control
Impact on Percent of DMIE Participants Not Working in the Past Month, 6 to 12 Months after Enrollment
Percent Not Working in Treatment
Percent Not Working in Control
Difference (Impact)*
P-value
Two States
4.6
5.2
-0.6
.56
Minnesota
9.9
11.6
-1.7
.49
Texas
0.7
0.6
0.1
.77
Kansas
2.0
6.6
-4.6
.02
Hawaii
4.2
0.0
.09
* Regression-adjusted impact estimates. Two states in first row are Minnesota and Texas.

13. Average Hours in Treatment Average Hours in Control
Average Monthly Hours Worked by DMIE Participants 6 to 12 Months after Enrollment
Average Hours in Treatment
Average Hours in Control
Difference (Impact)*
P-value
Two States
120.4
119.5
0.9
.72
Minnesota
114.5
112.1
2.4
.60
Texas
124.6
124.5
0.1
.99
Kansas
147.7
137.0
10.7
.09
Hawaii
128.5
159.9
-31.4
<.01
* Regression-adjusted impact estimates. Two states in first row are Minnesota and Texas.

14. Summary of Findings
Most participants with a potentially disabling condition report working at least half time.
Early intervention programs for working adults with potential disabling condition led to reduction in applications for federal disability benefits.
Evidence on impact of early intervention programs on employment status or hours worked in the short run is mixed.

15. Policy Implications
DMIE represents robust model for identifying working-age adults with potentially disabling conditions and providing them services designed to maintain independence and employment
Early intervention programs for individuals with potentially disabling conditions:
may be cost effective strategy for preventing or delaying onset of disability
have potential to benefit large number of working adults at risk of becoming disabled
focus on pre-disabled population and can be targeted on high-cost and/or high-impact conditions

16. Policy Implications
Model may be relevant for health reform by providing enhanced medical and employment services to at-risk individuals within an existing health insurance plan.

17. Contact Information
Boyd Gilman, Ph.D.
Mathematica Policy Research
955 Massachusetts Avenue, Suite 801
Cambridge, MA 02139
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