June 22, 2020

Those with severe mental illness (SMI), such as major depression, bipolar disorder or schizophrenia, utilize primary care services at a lower rate than many other people and are at a higher risk of poor health outcomes. To address this concern, medical home care has been utilized to assist people with SMI in managing their conditions. This model not only connects a patient to a primary care provider who can coordinate access to additional specialist care, but it also includes more patient-centered qualities than standard primary care, such as a team-based approach, whole-person orientation and a greater focus on evidence-based practices.

A recent study from the UNC Gillings School of Public Health has found that these medical homes provide a similar quality of care to individuals with SMI across several different practice types.

Dr. Marisa Domino

Dr. Marisa Domino

Dr. Joseph Morrissey

Dr. Joseph Morrissey

The study, which was recently published in Administration and Policy in Mental Health and Mental Health Services Research, initially sought to determine whether Federally Qualified Health Centers (FQHC) had performance advantages over medical homes in other settings, such as group or individual practices, when caring for people with SMI. Professor Marisa Domino, PhD, and Emeritus Professor Joseph Morrissey, PhD, both of the Department of Health Policy and Management, were part of the research team.

“We wanted to better understand whether there are conditions that make different types of primary care practices more effective for people with severe and persistent mental illnesses,” said Domino.

By modeling data the from North Carolina Medicaid program, the team estimated the effects of different types of medical home settings on monthly service utilization, medication adherence and total Medicaid spending over a 4-year period for adults ages 18 and older who were enrolled in N.C. Medicaid and were diagnosed with a major depressive disorder, bipolar disorder or schizophrenia.

Although FQHCs often focus on meeting the unique social challenges that people with SMIs face, like lack of insurance, low income and limited access to care, the team found that the variance in outcomes was relatively minimal between FQHCs and other types of medical homes. Adults with major depressive or bipolar disorders who were in FQHC settings had a slightly lower probability of hospital use and outpatient visits, but those with schizophrenia showed no significant differences in health care use. The type of medical home setting or patient illness also had no effect on Medicaid spending.

“We used empirical methods that helped to separate the differences in the types of patients that select these different models of health care from the effect the models had on their patterns of health care use,” Domino explained. “Even incorporating this information, we didn’t find that any of these three models of care outperformed any other for this population.”

Based on the relatively minor differences found in the study, health care practitioners do not need to steer those with SMIs who are enrolled in a Medicaid program towards a specific type of medical home practice. However, future studies may help researchers understand what causes these minor differences. Do those in an FQHC setting make fewer outpatient visits because the quality of primary care in these facilities is more efficient? Further research could have a significant impact on future care recommendations for those with severe mental illness.


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

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