Abstract
To identify whether medical homes in FQHCs have advantages over other group and individual medical practices in caring for people with severe mental illness. Models estimated the effect of the type of medical home on monthly service utilization, medication adherence, and total Medicaid spending over a 4-year period for adults aged 18 or older with a major depressive disorder (N = 65,755), bipolar disorder (N = 19,925), or schizophrenia (N = 8501) enrolled in North Carolina’s Medicaid program. Inverse probability of treatment weights (IPTW) were used to adjust for nonrandom assignment of patients to practices. Generalized estimating equations for repeated measures were used with gamma distributions and log links for the continuous measures of medication adherence and spending, and binomial distributions with logit links for binary measures of any outpatient or any emergency department visits. Adults with major depression or bipolar disorders in FQHC medical homes had a lower probability of outpatient service use than their counterparts in individual and group practices. The probability of emergency department use, medication adherence, and total Medicaid spending were relatively similar across the three settings. This study suggests that no one type of medical practice setting—whether FQHC, other group, or individual—consistently outperforms the others in providing medical home services to people with severe mental illness.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adashi, E. Y., Geiger, H. J., & Fine, M. D. (2010). Health care reform and primary care—The growing importance of the community health center. New England Journal of Medicine, 362(22), 2047–2050.
Agency for Healthcare Research and Quality. (2014). Outcomes of serious mental illness. Rockville, MD: Agency for Healthcare research and Quality.
Alakeson, V., Frank, R. G., & Katz, R. E. (2010). Specialty care medical homes for people with severe, persistent mental disorders. Health Affairs, 29(5), 867–873.
Austin, P. C. (2009). The relative ability of different propensity score methods to balance measured covariates between treated and untreated subjects in observational studies. Medical Decision Making, 29(6), 661–677.
Beal, A., & Hernandez, S. (2010). Patient reports of the quality of care in community health centers: The importance of having a regular provider. Journal of Health Care for the Poor and Underserved, 21(2), 591–605.
Benner, J. S., Glynn, R. J., Mogun, H., Neumann, P. J., Weinstein, M. C., & Avorn, J. (2002). Long-term persistence in use of statin therapy in elderly patients. JAMA, 288, 455–456.
Bradford, D. W., Kim, M. M., Braxton, L. E., Marx, C. E., Butterfield, M., & Elbogen, E. B. (2008). Access to medical care among persons with psychotic and major affective disorders. Psychiatric Services, 59(8), 847–852.
Brunero, S., & Lamont, S. (2010). Health behaviour beliefs and physical health risk factors for cardiovascular disease in an outpatient sample of consumers with a severe mental illness: A cross-sectional survey. International Journal of Nursing Studies, 47(6), 753–760.
Carrier, E., Gourevitch, M. N., & Shah, N. R. (2009). Medical homes: Challenges in translating theory into practice. Medical Care, 47(7), 714–722.
Center for Medicare and Medicaid Services (CMS). (2018). CMS announces new medicaid demonstration opportunity to expand mental health treatment services. Retrieved March 20, 2020, from https://www.cms.gov/newsroom/press-releases/cms-announces-new-medicaid-demonstration-opportunity-expand-mental-health-treatment-services.
Chwastiak, L., Cruza-Guet, M. C., Carroll-Scott, A., Sernyak, M., & Ickovics, J. (2013). Preventive counseling for chronic disease: Missed opportunities in a community mental health center. Psychosomatics, 54(4), 328–335.
Croghan, T. W., & Brown, J. D. (2010). Integrating mental health treatment into the patient centered medical home. Rockville, MD: Agency for Healthcare research and Quality.
David, G., Gunnarsson, C., Saynisch, P. A., Chawla, R., & Nigam, S. (2015). Do patient-centered medical homes reduce emergency department visits? Health Services Research, 50(2), 418–439.
Department of Mental Health and Missouri HealthNet. (2013). Progress report: Missouri CMHC Healthcare Homes. Jefferson City, MO: Department of Mental Health and Missouri HealthNet.
Dobson, L. A., Jr., & Hewson, D. L. (2009). Community care of North Carolina—An enhanced medical home model. North Carolina Medical Journal, 70(3), 219–224.
Domino, M. E., Kilany, M., Wells, R., & Morrissey, J. P. (2017). Through the looking glass: Estimating effects of medical homes for people with severe mental illness. Health Services Research, 52(5), 1858–1880.
Domino, M. E., Wells, R., & Morrissey, J. P. (2015). Serving persons with severe mental illness in primary care–based medical homes. Psychiatric Services, 66(5), 477–483.
Druss, B. G., Rohrbaugh, R. M., Levinson, C. M., & Rosenheck, R. A. (2001). Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives Of General Psychiatry, 58(9), 861–868.
Gierisch, J. M., Nieuwsma, J. A., Bradford, D. W., Wilder, C. M., Mann-Wrobel, M. C., McBroom, A. J., et al. (2013). Interventions to improve cardiovascular risk factors in people with serious mental illness. Compartive effectiveness review. Rockville, MD: Agency for Healthcare research and Quality.
Goldman, L. E., Chu, P. W., Tran, H., Romano, M. J., & Stafford, R. S. (2012). Federally qualified health centers and private practice performance on ambulatory care measures. American Journal of Preventive Medicine, 43(2), 142–149.
Golomb, B. A., Pyne, J. M., Wright, B., Jaworski, B., Lohr, J. B., & Bozzette, S. A. (2000). The role of psychiatrists in primary care of patients with severe mental illness. Psychiatric Services, 51(6), 766–773.
Grove, L. R., Olesiuk, W. J., Ellis, A. R., Lichstein, J. C., DuBard, C. A., Farley, J. F., et al. (2017). Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia. General Hospital Psychiatry, 47, 14–19.
Hall, R. C., Beresford, T. P., Gardner, E. R., & Popkin, M. K. (1982). The medical care of psychiatric patients. Hospital & Community Psychiatry, 33(1), 25–34.
Jones, R., Major, B., & Fear, C. (2015). Schizophrenia in a primary care setting. Current Psychiatry Reports, 17(10), 84.
Kahn, K. L., Timbie, J. W., Friedberg, M. W., Lavelle, T., Mendel, P., Ashwood, J. S., et al. (2015). Evaluation of CMS's Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) demonstration: Final second annual report. Santa Monica, CA: RAND Corporation.
Kronick, R., Gilmer, T., Dreyfus, T., & Lee, L. (2000). Improving health-based payment for Medicaid beneficiaries: CDPS. Health Care Financing Review, 21(3), 29–64.
Lester, H., Tritter, J. Q., & Sorohan, H. (2005). Patients' and health professionals' views on primary care for people with serious mental illness: Focus group study. British Medical Journal, 330(7500), 1122.
Martin, B. C., Wiley-Exley, E. K., Richards, S., Domino, M. E., Carey, T. S., & Sleath, B. L. (2009). Contrasting measures of adherence with simple drug use, medication switching, and therapeutic duplication. The Annals of Pharmacotherapy, 43, 36–44.
Miller, B. F., Ross, K. M., Davis, M. M., Melek, S. P., Kathol, R., & Gordon, P. (2017). Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care. American Psychologist, 72(1), 55–68.
Osborn, R., Moulds, D., Schneider, E. C., Doty, M. M., Squires, D., & Sarnak, D. O. (2015). Primary care physicians in ten countries report challenges caring for patients with complex health needs. Health Affairs (Millwood), 34(12), 2104–2112.
Parks, J., Pollack, D., & Bartels, S. (2005). Integrating behavioral health and primary care services: Opportunities and challenges for state mental health authorities. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Cuncil.
Parks, J., Svendsen, D., Singer, P., & Foti, M. E. (2006). Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Cuncil.
Politzer, R. M., Yoon, J., Shi, L., Hughes, R. G., Regan, J., & Gaston, M. H. (2001). Inequality in America: The contribution of health centers in reducing and eliminating disparities in access to care. Medical Care Research and Review, 58(2), 234–248.
Rhodes, K. V., Basseyn, S., Gallop, R., Noll, E., Rothbard, A., & Crits-Christoph, P. (2016). Pennsylvania’s medical home initiative: Reductions in healthcare utilization and cost among Medicaid patients with Medicaland psychiatric comorbidities. Journal of General Internal Medicine, 31(11), 1373–1381.
Rosenthal, M. B., Beckman, H. B., Forrest, D. D., Huang, E. S., Landon, B. E., & Lewis, S. (2010). Will the patient-centered medical home improve efficiency and reduce costs of care? A measurement and research agenda. Medical Care Research and Review, 67(4), 476–484.
Scharf, D. M., Eberhart, N. K., Schmidt, N., Vaughan, C. A., Dutta, T., Pincus, H. A., et al. (2013). Integrating primary care into community behavioral health settings: Programs and early implementation experiences. Psychiatric Services, 64(7), 660–665.
Shi, L., & Stevens, G. D. (2007). The role of community health centers in delivering primary care to the underserved: Experiences of the uninsured and Medicaid insured. Journal of Ambulatory Care Management, 30(2), 159–170.
Shin, P., Markus, A., Rosenbaum, S., & Sharac, J. (2008). Adoption of health center performance measures and national benchmarks. Journal of Ambulatory Care Management, 31(1), 69–75.
Steiner, B. D., Denham, A. C., Ashkin, E., Newton, W. P., Wroth, T., & Dobson, L. A., Jr. (2008). Community care of North Carolina: Improving care through community health networks. Annals of Family Medicine, 6(4), 361–367.
Timbie, J. W., Setodji, C. M., Kress, A., Lavelle, T. A., Friedberg, M. W., Mendel, P. J., et al. (2017). Implementation of medical homes in federally qualified health centers. New England Journal of Medicine, 377(3), 246–256.
Wells, R., Morrissey, J. P., Lee, I. H., & Radford, A. (2010). Trends in behavioral health care service provision by community health centers, 1998–2007. Psychiatric Services, 61(8), 759–764.
Funding
Funding for data set creation was provided by NARSAD and the North Carolina Translational and Clinical Sciences Institute. Dr. Kilany received addition support from a National Research Service Award Postdoctoral Traineeship from the National Institute of Mental Health, Grant No: T32 MH019117.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Domino has conducted unrelated funded work collaboratively with CCNC staff. The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at the University of North Carolina at Chapel Hill and with the 1964 Helsinki declaration and its later. This article does not contain any studies with animals performed by any of the authors.
Informed Consent
Because of the use of secondary data on a large group of Medicaid enrollees, a waiver of informed consent was obtained.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kilany, M., Wells, R., Morrissey, J.P. et al. Are There Performance Advantages Favoring Federally Qualified Health Centers in Medical Home Care for Persons with Severe Mental Illness?. Adm Policy Ment Health 48, 121–130 (2021). https://doi.org/10.1007/s10488-020-01050-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-020-01050-1