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Through the Looking Glass: Estimating Effects of Medical Homes for People with Severe Mental Illness
Author(s) -
Domino Marisa Elena,
Kilany Mona,
Wells Rebecca,
Morrissey Joseph P.
Publication year - 2017
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12585
Subject(s) - mental illness , medicaid , medicine , medical expenditure panel survey , mental health , medical diagnosis , psychiatry , estimation , instrumental variable , specialty , depression (economics) , family medicine , gerontology , health care , health insurance , pathology , machine learning , computer science , economics , economic growth , management , macroeconomics
Objective To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques. Data Sources/Study Setting Secondary claims data from the NC Medicaid program for 2004–2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility. Study Design We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses. Data Collection Data were received from the Carolina Cost and Quality Initiative. Principal Findings The four estimation techniques consistently revealed generally positive associations between medical homes and access to primary care, specialty mental health care, greater medication adherence, slightly lower emergency room use, and greater expenditures. These findings were consistent across all three major severe mental illness diagnostic groups. Some heterogeneity in effects were noted, especially in preventive screening. Conclusions Expanding access to primary care–based medical homes for people with severe mental illness may not save money for insurance providers, due to greater access for important outpatient services with little cost offset. Health services research examining more of the treatment heterogeneity may contribute to more realistic projections about medical homes outcomes.