May 27, 2020

Medical home care models — which connect patients to a primary care provider who can help manage their health and coordinate access to specialist care — have been effective in assisting those with serious mental illness reduce visits to emergency rooms and increase access to outpatient health care, like primary care visits. For those with both mental and physical illnesses, this model could decrease hospital admissions and increase access to outpatient services, according to findings from a new study that includes research from the UNC Gillings School of Global Public Health.

Dr. Marisa Domino

Dr. Marisa Domino

Lexie Grove

Lexie Grove

The study, published recently in the American Journal of Managed Care, was co-led by a team that included doctoral student Lexie Grove, MSPH, and Professor Marisa Domino, PhD, both of the Department of Health Policy and Management.

The team reviewed North Carolina Medicaid claims and other administrative data about participants who enrolled in the medical homes program in comparison to those who did not enroll. The aim was to determine what kind of impact the program had on costs and acute and outpatient medical visits for patients who had major depression or schizophrenia in addition to a chronic illness like hypertension, diabetes, seizure disorder or asthma.

“Previous research on the medical home model has focused on people with serious mental illness or people with multiple chronic conditions but not necessarily both,” Grove stated. “We wanted to study those with both a mental and physical illness because they have distinct health needs.”

Overall, the study found that while outpatient visits increased for all participants in the medical homes program, medical home care had different effects on those with major depression as compared to those with schizophrenia. The probability of inpatient hospital admissions for patients with depression was, on average, 19.8% lower for those in the medical homes program than those not enrolled. In contrast, medical home care was shown to have no significant impact on inpatient admissions among patients with schizophrenia.

Visits to the emergency department, however, did not decrease for patients enrolled in the medical homes program, regardless of the type of mental illness they had. This could be because it is more difficult for outpatient providers to manage the complexities of care for a patient with both a physical and mental illness.

In terms of cost, the Medicaid program saw a 12.4% rise in expenditures for adults with schizophrenia in medical homes, mostly due to increased outpatient visits. Patients with depression who were in medical home care also made more outpatient visits but overall saw a 13.3% decrease in Medicaid expenditures.

The results of the study indicate that a medical home care model may be beneficial for helping patients with both mental and physical illnesses get connected with primary care providers and gain access to increased referrals for specialty care. While patients with schizophrenia saw no decrease in acute care visits or medical expenditures, more information could help researchers determine whether the increase in spending could be seen as an investment in addressing unmet needs for outpatient care.

Future research will help the team in understanding whether access to medical home care services improves outcomes for patients with these complex conditions.

According to Domino, “although we tend to think of specialty mental health providers as the core of treatment for adults with severe mental illnesses, such as schizophrenia or major depressive disorder, these findings show that we can still move the needle towards better patterns of care through enhancements to primary care.”


Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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