Date of Award

Spring 5-16-2020

Degree Type

Dissertation

Degree Name

Doctor of Social Work (DSW)

First Advisor

Solomon, Phyllis; University of Pennsylvania

Second Advisor

Manderscheid, Ronald; John Hopkins, Bloomberg School of Public Health

Third Advisor

Cantor, Joel; Center for State Health Policy, Rutgers University

Abstract

Purpose: Individuals with serious mental illness (SMI) die 15-25 years sooner than the general population and typically have preventable co-morbid medical illnesses. Behavioral Health Home (BHH) is an integrated care intervention designed to coordinate physical and behavioral health care for individuals with SMI with expectation of improved health outcomes. This study was to determine to what extent BHH and BHH with Primary Care intervention models have an impact on Medicaid members’ health outcomes, and were these BHH interventions more effective in improving healthcare outcomes, costs and utilization than treatment as usual (TAU). Method: Using state administrative data, this quasi-experimental longitudinal study compared health outcomes of individuals with SMI who were receiving BHH intervention (n=322) with those receiving BHH & Primary Care intervention (n=91); comparing individual’s health outcomes to the first year in the intervention to their second year in interventions; and, comparing healthcare utilization and costs of both groups to one receiving TAU (n=823). A difference-in-differences design was used to isolate the effect of BHH participation on healthcare costs and utilization outcomes calculated for all individuals in pre and post-intervention period. Results: Both BHH interventions had an impact on health care costs and utilization compared to TAU with fewer inpatient hospitalizations, physical health related and ED visits, while both BHH interventions costs increased due to a surge in behavioral healthcare spending. Conclusions: This study elucidates the need to evaluate longer-term impact of BHHs and other integrated care models for individuals with SMI on both Medicaid spending and change in health outcomes.

Available for download on Saturday, May 15, 2021

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