Approximately 10 million US adults have a Serious Mental Illness (SMI). These individuals have higher rates of morbidity and shorter life-expectancies than the general population. Persons with SMI are at increased risk of visiting the emergency room and being hospitalized due to multiple comorbidities; and, inconsistent or nonexistent use of outpatient services. To address health disparities, section 2703 of the Affordable Care Act allocated funds for Health Homes (HH), patient-centered care that afford the chronically ill with comprehensive behavioral and primary care services. This dissertation describes an evaluation of Rhode Island’s (RI) HH program, which provided coordinated and integrated care to Medicaid beneficiaries with SMI who used community mental health centers (CMHC) as their medical home. The aims of this dissertation were 1) evaluate the extent to which HH impacted outpatient service use; 2) establish the degree to which hospital and emergency department use were affected by HH; and 3) identify the care setting that impacted health services use among HH participants. Using RI Medicaid claims (2009-2012) and a quasi-experimental difference-in-differences approach with propensity score weighting, health service use was evaluated before and after the introduction of HH. In Chapter 1, findings suggest HH was associated with an increase in outpatient service use, overall and for visits associated with obesity and chronic obstructive pulmonary disease. Chapter 2 results showed HH was associated with a decrease in the proportion having a hospitalization for acute ambulatory care sensitive conditions and for non-mental illness conditions. Additionally, HH was associated with a decrease in emergency department use for non-mental illness conditions. Findings also indicated HH was associated with an increase in the proportion having a hospitalization for a mental illness as well as an increase in the number of emergency department visits for all-cause and non-mental illness conditions. In Chapter 3, results suggest HH participants within an integrated care setting experienced a decrease in the proportion having a hospitalization for all-cause and non-mental illness conditions. Investment in CMHC based integration can improve access to and use of outpatient services as well as decrease hospital and emergency department use among Medicaid beneficiaries with SMI.
Flores, Michael W.,
"Evaluation of Rhode Island's Health Home Initiative"
(2018).
Health Services, Policy & Practice Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.26300/v2pg-xj56
