Medical home effects on enrollees with mental and physical illness

Lexie R. Grove, Marisa Elena Domino, Joel F. Farley, Karen E. Swietek, Christopher Beadles, Alan R. Ellis, Carlos T. Jackson, C. Annette DuBard

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To assess the effect of medical home enrollment on acute care use and healthcare spending among Medicaid beneficiaries with mental and physical illness. STUDY DESIGN: Retrospective cohort analysis of administrative data. METHODS: We used 2007-2010 Medicaid claims and state psychiatric hospital data from a sample of 83,819 individuals diagnosed with schizophrenia or depression and at least 1 comorbid physical condition. We performed fixed-effects regression analysis at the person-month level to examine the effect of medical home enrollment on the probabilities of emergency department (ED) use, inpatient admission, and outpatient care use and on amount of Medicaid spending. RESULTS: Medical home enrollment had no effect on ED use in either cohort and was associated with a lower probability of inpatient admission in the depression cohort (P <.05). Medical home enrollees in both cohorts experienced an increase in the probability of having any outpatient visits (P <.05). Medical home enrollment was associated with an increase in mean monthly spending among those with schizophrenia ($65.8; P <.05) and a decrease among those with depression (-$66.4; P <.05). CONCLUSIONS: Among Medicaid beneficiaries with comorbid mental and physical illness, medical home enrollment appears to increase outpatient healthcare use and has mixed effects on acute care use. For individuals in this population who previously had no engagement with the healthcare system, use of the medical home model may represent an investment in providing improved access to needed outpatient services with cost savings potential for beneficiaries with depression.

Original languageEnglish (US)
Pages (from-to)218-223
Number of pages6
JournalAmerican Journal of Managed Care
Volume26
Issue number5
DOIs
StatePublished - May 2020

Bibliographical note

Funding Information:
Agency for Healthcare Research and Quality (grant No. R24 HS019659-01). This research was partially supported by a National Research Service Award Pre-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, grant No. T32-HS000032.

Funding Information:
Source of Funding: Agency for Healthcare Research and Quality (grant No. R24 HS019659-01). This research was partially supported by a National Research Service Award Pre-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, grant No. T32-HS000032.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, P.H.S.

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