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National and State-Level Trends in Mental Health and Substance Use Disorder Services at Federally Qualified Health Centers, 2012–2019

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Abstract

Introduction

A disproportionate share of Federally Qualified Health Center (FQHC) users have a behavioral health condition, but there exists limited research examining changes in behavioral health provision in FQHCs. The objectives of this study were to describe how the provision of behavioral health services by FQHCs to the population of people with behavioral health conditions has changed over time in the US, how these trends varied across states, and whether the proportion of total delivered services that are behavioral health services has changed within FQHCs over time.

Methods

Descriptive analysis using the Uniform Data System and Global Burden of Disease Datasets from years 2012 to 2019.

Results

From 2012 to 2019, FQHC behavioral health visits per 1,000 population with any behavioral health condition grew 103%, with a 26-fold difference in average rates across states during the study period. Annual behavioral health visits per patient increased from 3.2 to 2012 to 3.4 in 2019. From 2012 to 2019, the number of behavioral health visits per 1,000 FQHC patients grew by 51%, whereas the rate of asthma visits declined by 14%, heart disease visits declined by 4%, and hypertension and diabetes related visits remained stable (changing < 1% for both).

Discussion/Conclusion

Behavioral health visit growth at FQHCs outpaced national prevalence of behavioral health conditions. This growth was driven by FQHCs serving an increasing number of patients with behavioral health conditions, without sacrificing the frequency of visits for individual patients with behavioral health conditions.

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References

  1. Wakefield, M. (2021). Federally qualified Health Centers and related primary care workforce issues. Journal of the American Medical Association, 325(12), 1145–1146. https://doi.org/10.1001/jama.2021.1964.

    Article  PubMed  Google Scholar 

  2. Community Health Center Patients by Payer Source. Kaiser Family Foundation. Retrieved September 12 (2023). from https://www.kff.org/other/state-indicator/chc-patients-by-payer-source/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

  3. 2021 Health Center Data. Uniform Data System. Health Resources and Services Administration Retrieved August 10 (2022). from https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=Full&year=2021

  4. Saunders, H., & Rudowitz, R. (2022). Demographics and Health Insurance Coverage of Nonelderly Adults with Mental Illness and Substance Use Disorders in 2020. Kaiser Family Foundation. June 6, Retrieved September 12, 2023, from https://www.kff.org/medicaid/issue-brief/demographics-and-health-insurance-coverage-of-nonelderly-adults-with-mental-illness-and-substance-use-disorders-in-2020/.

  5. 42 USC 254b: Health Centers. US House of Representatives. Retrieved September 12 (2023). from http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim.

  6. Behavioral Health and Primary Care Integration. Health Resources & Services Administration. Retrieved September 12 (2023). from https://bphc.hrsa.gov/technical-assistance/clinical-quality-improvement/behavioral-health-primary-care-integration.

  7. Jones, E. B. (2018). Medication-assisted opioid treatment prescribers in federally qualified Health Centers: Capacity lags in rural areas. Journal of Rural Health, 34(1), 14–22. https://doi.org/10.1111/jrh.12260Epub 2017 Aug 26.

    Article  Google Scholar 

  8. Krupski, A., West, I. I., Scharf, D. M., Hopfenbeck, J., Andrus, G., Joesch, J. M., & Snowden, M. (2016). Integrating primary care into community mental health centers: Impact on utilization and costs of health care. Psychiatric Services, 67(11), 1233–1239. https://doi.org/10.1176/appi.ps.201500424.

    Article  PubMed  Google Scholar 

  9. Lanoye, A., Stewart, K. E., Rybarczyk, B. D., Auerbach, S. M., Sadock, E., Aggarwal, A., Waller, R., Wolver, S., & Austin, K. (2017). The impact of integrated psychological services in a safety net primary care clinic on medical utilization. Journal of Clinical Psychology, 73(6), 681–692. https://doi.org/10.1002/jclp.22367.

    Article  PubMed  Google Scholar 

  10. Peterson, L., Murugesan, M., Nocon, R., Hoang, H., Bolton, J., Laiteerapong, N., Pollack, H., & Marsh, J. (2022). Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in federally qualified Health Centers and other primary care settings. PLoS One, 17(10), e0276066. https://doi.org/10.1371/journal.pone.0276066.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kim, J., Sheldrick, R. C., Gallagher, K., Bair-Merritt, M. H., Durham, M. P., Feinberg, E., Morris, A., & Cole, M. B. (2023). Association of integrating Mental Health into Pediatric Primary Care at federally qualified Health Centers with utilization and follow-up care. JAMA Netw Open, 6(4), e239990.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bruckner, T. A., Singh, P., Snowden, L. R., Yoon, J., & Chakravarthy, B. (2019). Rapid Growth of Mental Health Services at Community Health Centers. Administration and Policy in Mental Health, 46(5), 670–677. https://doi.org/10.1007/s10488-019-00947-w.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Substance Abuse and Mental Health Services Administration (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved September 12, 2023 from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report.

  14. Priester, M. A., Browne, T., Iachini, A., Clone, S., DeHart, D., & Seay, K. D. (2016). Treatment Access Barriers and Disparities among individuals with Co-Occurring Mental Health and Substance Use Disorders: An integrative literature review. Journal of Substance Abuse Treatment, 61, 47–59. Epub 2015 Oct 31.

    Article  PubMed  Google Scholar 

  15. Saunders, H., Guth, M., & Eckart, G. (2023). A Look at Strategies to Address Behavioral Health Workforce Shortages: Findings from a Survey of State Medicaid Programs. Kaiser Family Foundation. January 10, Retrieved September 12, 2023 from https://www.kff.org/mental-health/issue-brief/a-look-at-strategies-to-address-behavioral-health-workforce-shortages-findings-from-a-survey-of-state-medicaid-programs/.

  16. Wen, H., Wilk, A. S., Druss, B. G., & Cummings, J. R. (2019). Medicaid Acceptance by Psychiatrists before and after Medicaid Expansion. JAMA Psychiatry, 76(9), 981–983. https://doi.org/10.1001/jamapsychiatry.2019.0958.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cummings, J. R., Wen, H., Ko, M., & Druss, B. G. (2013). Geography and the Medicaid Mental Health Care infrastructure: Implications for Health Care Reform. JAMA Psychiatry, 70(10), 1084–1090. https://doi.org/10.1001/jamapsychiatry.2013.377.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lewis, C., Coleman, A., Abrams, M., & Doty, M. (2019). The Role of Medicaid Expansion in Care Delivery at Community Health Centers, Issue Brief 2019. Commonwealth Fund April 4, Retrieved September 12, 2023 from https://www.commonwealthfund.org/publications/issue-briefs/2019/apr/role-medicaid-expansion-care-delivery-FQHCs.

  19. Health Centers: Trends in Revenue and Grants Supported by the Community Health Center Fund. US Government Accountability Office. March 2 (2023). Retrieved September 12, 2023 from https://www.gao.gov/products/gao-23-106664.

  20. Guth, M., Saunders, H., Corallo, B., & Moreno, S. (2023). Medicaid Coverage of Behavioral Health Services in 2022: Findings from a Survey of State Medicaid Programs. Kaiser Family Foundation. March 17, Retrieved September 14, 2023 from https://www.kff.org/mental-health/issue-brief/medicaid-coverage-of-behavioral-health-services-in-2022-findings-from-a-survey-of-state-medicaid-programs/.

  21. State Funding for Community Health Centers (Fiscal Year 2016). National Association of Community Health Centers December 2015. Retrieved September 14, 2023 from https://www.nachc.org/wp-content/uploads/2023/03/funding-brief-3-21-16.pdf.

  22. Health Resources and Services Administration. Uniform Data System (UDS) Resources. [Internet]. Rockville (MD): HRSA. Retrieved September 15 (2023). from https://data.hrsa.gov/tools/data-reporting/program-data.

  23. Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Retrieved March 15 (2023). from http://vizhub.healthdata.org/gbd-compare.

  24. Vechiu, C., Zimmermann, M., Zepeda, M., O’Donohue, W. T., & Broten, L. (2023 Aug). Referral patterns and Sociodemographic Predictors of Adult and Pediatric behavioral health referrals in a federally qualified Health Center. The Journal of Behavioral Health Services & Research, 16, https://doi.org/10.1007/s11414-023-09855-2.

  25. Siantz, E., Henwood, B., Rabin, B., Center, K., Fenwick, K., & Gilmer, T. (2021). A Mixed-method Evaluation of the Behavioral Health Integration and Complex Care Initiative Using the Consolidated Framework for Implementation Research. Med Care. ;59(7):632–638. https://doi.org/10.1097/MLR.0000000000001569. PMID: 33989248.

  26. Goldstein, E. V. (2017). Integrating Mental and Physical Health Care for Low-Income Americans: Assessing a Federal Program’s initial impact on Access and cost. Healthcare (Basel), 5(3), 32. https://doi.org/10.3390/healthcare5030032PMID: 28704970; PMCID: PMC5618160.

    Article  PubMed  Google Scholar 

  27. Bowen, D. J., Heald, A., LePoire, E., Jones, A., Gadbois, D., Russo, J., & Carruthers, J. (2021). Population-based implementation of behavioral health detection and treatment into primary care: Early data from New York state. Bmc Health Services Research, 21(1), 922. https://doi.org/10.1186/s12913-021-06892-5PMID: 34488741; PMCID: PMC8420002.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kern, J. S., & Cerimele, J. M. (2019). Collaborative Care for Patients With a Bipolar Disorder: A Primary Care FQHC-CMHC Partnership. Psychiatr Serv. ;70(4):353. https://doi.org/10.1176/appi.ps.201900019. PMID: 30929615.

  29. Hunter, C. L., Dobmeyer, A. C., Reiter, J. T., & Integrating Behavioral Health Services into Primary Care. (2018). : Spotlight on the Primary Care Behavioral Health (PCBH) Model of Service Delivery. J Clin Psychol Med Settings. ;25(2):105–108. https://doi.org/10.1007/s10880-017-9534-7. PMID: 29352370.

  30. Possemato, K., Johnson, E. M., Beehler, G. P., Shepardson, R. L., King, P., Vair, C. L., Funderburk, J. S., Maisto, S. A., & Wray, L. O. Patient outcomes associated with primary care behavioral health services: A systematic review. Gen Hosp Psychiatry 2018 Jul-Aug;53:1–11. https://doi.org/10.1016/j.genhosppsych.2018.04.002.

  31. Certified Community Behavioral Health Clinics Program: Report to Congress (2018). Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services. September 9, 2019. Retrieved September 12, 2023 from https://aspe.hhs.gov/reports/certified-community-behavioral-health-clinics-demonstration-program-report-congress-2018-0.

  32. Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Frequently Asked Questions. Centers for Medicare and Medicaid Services (December 2019). Retrieved September 12, 2023 from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-RHC-FAQs.pdf.

  33. Fiscal year 2019 Integrated Behavioral Health Services (IBHS) Supplemental Funding. Health Resources and Services Administration April 18 (2019). Retrieved September 12, 2023 from https://bphc.hrsa.gov/funding/funding-opportunities/fy-2019-integrated-behavioral-health-services-ibhs-supplemental-funding-hrsa-19-100.

  34. Health Homes. Centers for Medicare and Medicaid Services. Retrieved September 12 (2023). from https://www.medicaid.gov/medicaid/long-term-services-supports/health-homes/index.html.

  35. Patient-Centered Medical Home. National Committee for Quality Assurance Retrieved September 12 (2023). from https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/.

  36. Musumeci, M. (2017). Key Themes in Medicaid Sect. 1115 Behavioral Health Waivers. Kaiser Family Foundation. November 10, Retrieved September 12, 2023 from https://www.kff.org/mental-health/issue-brief/key-themes-in-medicaid-section-1115-behavioral-health-waivers/.

  37. Guth, M. (2021). State Policies Expanding Access to Behavioral Health Care in Medicaid. Kaiser Family Foundation. December 9, Retrieved September 12, 2023 from https://www.kff.org/mental-health/issue-brief/state-policies-expanding-access-to-behavioral-health-care-in-medicaid/.

  38. Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 (and 2020). Kaiser Family Foundation October 2019. Retrieved September 12, 2023 from https://files.kff.org/attachment/Tables-Report-A-View-from-the-States-Key-Medicaid-Policy-Changes.

  39. Promoting Integration of Primary and Behavioral Health Care. Substance Abuse and Mental Health Services Administration, October 11 (2019). Retrieved September 12, 2023 from https://www.samhsa.gov/grants/grant-announcements/sm-20-003.

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No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Jonathan Staloff & Bianca Frogner

  2. Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA

    Megan B. Cole

  3. Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Amber K. Sabbatini

  4. Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA

    Amber K. Sabbatini

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  1. Jonathan Staloff
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Staloff, J., Cole, M.B., Frogner, B. et al. National and State-Level Trends in Mental Health and Substance Use Disorder Services at Federally Qualified Health Centers, 2012–2019. J Community Health 49, 343–354 (2024). https://doi.org/10.1007/s10900-023-01293-7

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