Abstract
Patient-centered medical homes based at federally-qualified health centers (FQHCs) can benefit patients with complex health needs, such as severe mental illness (SMI). However, little is known about FQHC characteristics associated with changes in health care expenditures and utilization for individuals with SMI. Using North Carolina Medicaid claims and FQHC data from the Uniform Data System, multivariate regression identified FQHC characteristics associated with total expenditures, medication adherence and emergency department utilization among adults with SMI, controlling for time-invariant differences by health center. Few of the FQHC-level factors affected the outcomes—not even offering on-site behavioral health services. Although the FQHCs in the analysis sample exhibited considerable variation in the provision of specialty behavioral services and in staffing configurations, it may be the case that the examination of average effects across a heterogeneous group of adults with SMI mask benefits of FQHCs to certain subgroups. These findings support the conclusion that there is no “one-size-fits-all” model that works best for this diverse patient population. Study results are relevant for practices embarking on expanded medical home services for people with SMI.
Similar content being viewed by others
Data Availability
Data access restricted by Data Use Agreement.
References
Sia C, Tonniges TF, Osterhus E, Taba S. History of the medical home concept. Pediatrics. 2004;113(5 Suppl):1473–8.
RTI International. Evaluation of the multi-payer advanced primary care practice (MAPCP) demonstration: Final report. 2017. RTI: research Triangle Park, NC.
Alexander JA, Markovitz AR, Paustian ML, Wise CG, el Reda DK, Green LA, et al. Implementation of patient-centered medical homes in adult primary care practices. Med Care Res Rev. 2015;72(4):438–67.
David G, Gunnarsson C, Saynisch PA, Chawla R, Nigam S. Do patient-centered medical homes reduce emergency department visits? Health Serv Res. 2015;50(2):418–39.
Paustian ML, Alexander JA, el Reda DK, Wise CG, Green LA, Fetters MD. Partial and incremental PCMH practice transformation: implications for quality and costs. Health Serv Res. 2014;49(1):52–74.
Hert MDE, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52–77.
Domino ME, Kilany M, Wells R, Morrissey JP. Through the looking glass: estimating effects of medical homes for people with severe mental illness. Health Serv Res. 2017;52(5):1858–80.
Domino ME, Wells R, Morrissey JP. Serving persons with severe mental illness in primary care–based medical homes. Psychiatr Serv. 2015;66(5):477–83.
Bradford DW, et al. Access to medical care among persons with psychotic and major affective disorders. Psychiatr Serv. 2008;59(8):847–52.
Grove LR, Olesiuk WJ, Ellis AR, Lichstein JC, DuBard CA, Farley JF, et al. Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia. Gen Hosp Psychiatry. 2017;47:14–9.
Shi L, Lebrun LA, Tsai J, Zhu J. Characteristics of ambulatory care patients and services: a comparison of community health centers and physicians' offices. J Health Care Poor Underserved. 2010;21(4):1169–83.
Wells R, et al. Trends in behavioral health care service provision by community health centers, 1998-2007. Psychiatr Serv. 2010;61(8):759–64.
American Academy of Family Physicians. Joint principles of the patient-centered medical home. 2007. Author: Leawood, KS.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.
Kahn, KL, et al. Evaluation of CMS’s Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration: Final Report RAND, editor. 2016.
Kilany, M, et al. Are there performance advantages for federally qualified health centers in medical home care for persons with severe mental illness? 2019. p. Manuscript submitted for publication.
Steiner BD, Denham AC, Ashkin E, Newton WP, Wroth T, Dobson LA. Community Care of North Carolina: improving care through community health networks. Ann Fam Med. 2008;6(4):361–7.
Linman S, Benjenk I, Chen J. The medical home functions of primary care practices that care for adults with psychological distress: a cross-sectional study. BMC Health Serv Res. 2019;19(1):21.
Mass.gov. The HPC Patient-Centered Medical Home (PCMH) Certification Program. 2019 12/16/2019]; Available from: https://www.mass.gov/service-details/the-hpc-patient-centered-medical-home-pcmh-certification-program.
Center for Health Care Strategies, I. Three State Approaches to Patient-Centered Medical Homes: Opportunities to Advance Primary Care Innovation through Medicaid Managed Care, CHCS. Editor. 2019.
Wells R, et al. Trends in behavioral health care service provision by community health centers, 1998-2007. Psychiatr Serv. 2010;61(8):759–64.
Jones EB, Ku L. Sharing a playbook: integrated Care in Community Health Centers in the United States. Am J Public Health. 2015;105(10):2028–34.
Frogner B, et al. Do years of experience with electronic health records matter for productivity in community health centers? J Ambul Care Manage. 2017;40:36–47.
Steiner BD, Denham AC, Ashkin E, Newton WP, Wroth T, Dobson LA. Community care of North Carolina: improving care through community health networks. Ann Fam Med. 2008;6(4):361–7.
Wooldridge JM. In: Wooldridge JM, editor. Prediction and residual analysis, in Introductory econometrics : a modern approach. Mason: South-Western; 2009. p. 206–14.
Wright B, Ricketts TC. When patients govern: federal grant funding and uncompensated care at federally qualified health centers. J Health Care Poor Underserved. 2013;24(2):954–67.
Busch AB, Huskamp HA, Landrum MB. Quality of care in a Medicaid population with bipolar I disorder. Psychiatr Serv. 2007;58(6):848–54.
University of California, S.D. Chronic illness and disability payment system. 2016 [cited 2016; Available from: http://cdps.ucsd.edu/.
Bao Y, Casalino LP, Pincus HA. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization. J Behav Health Serv Res. 2013;40(1):121–32.
Schuster J, Nikolajski C, Kogan J, Kang C, Schake P, Carney T, et al. A payer-guided approach to widespread diffusion of behavioral health homes in real-world settings. Health Aff (Millwood). 2018;37(2):248–56.
Stone, EM, et al. The policy ecology of behavioral health homes: case study of Maryland's Medicaid health home program. Adm Policy Ment Health. 2019.
Stewart RF, Kroth PJ, Schuyler M, Bailey R. Do electronic health records affect the patient-psychiatrist relationship? A before & after study of psychiatric outpatients. BMC Psychiatry. 2010;10:3–3.
Code Availability
Analysis code available upon request.
Author information
Authors and Affiliations
Contributions
All authors contributed to the conceptualization, analysis, and writing of the manuscript.
Corresponding author
Ethics declarations
Conflicts of Interest
None declared.
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
Whitaker, R.G., Kilany, M., Wells, R. et al. Are Certain Health Centers Better Patient-Centered Medical Homes for People with Severe Mental Illness?. Psychiatr Q 92, 107–122 (2021). https://doi.org/10.1007/s11126-020-09754-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11126-020-09754-1