Abstract
Physical comorbidities associated with mental health conditions contribute to high health care costs. This study examined the impact of having a usual source of care (USC) for physical health on health care utilization, spending, and quality for adults with a mental health condition using Medicaid administrative data. Having a USC decreased the probability of inpatient admissions and readmissions. It decreased expenditures on emergency department visits for physical health, 30-day readmissions, and behavioral health inpatient admissions. It also had a positive effect on several quality measures. Results underscore the importance of a USC for physical health and integrated care for adults with mental health conditions.
This is a preview of subscription content, log in via an institution to check access.
(Source Truven Health MarketScan Multi-State Medicaid Database, 2011–2012)
Similar content being viewed by others
References
Agency for Healthcare Research and Quality. (2015). Prevention Quality Overall Composite Technical Specifications: Prevention Quality Indicators #90. Rockville, MD: Agency for Healthcare Research and Quality. http://qualityindicators.ahrq.gov/downloads/modules/pqi/v50/techspecs/pqi_90_prevention_quality_overall_composite_.pdf.
Alegria, M., Jackson, J. S., Kessler, R. C., & Takeuchi, D. (2003). National Comorbidity Survey Replication (NCS-R), 2001–2003. Ann Arbor: Inter-university Consortium for Political and Social Research.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.
Basu, J., Friedman, B., & Burstin, H. (2002). Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions: A new approach. Medical Care, 40, 1260–1269.
Blewett, L. A., Johnson, P. J., Lee, B., & Scal, P. B. (2008). When a usual source of care and usual provider matter: Adult prevention and screening services. Journal of General Internal Medicine, 23, 1354–1360. https://doi.org/10.1007/s11606-008-0659-0.
Bradford, D. W., Kim, M. M., Braxton, L. E., Marx, C. E., Butterfield, M., & Elbogen, E. B. (2008). Access to medical care among persons with psychotic and major affective disorders. Psychiatric Services, 59(8), 847–852. https://doi.org/10.1176/ps.2008.59.8.847.
Center for Substance Abuse Treatment. (1998). Contracting for Managed Substance Abuse and Mental Health Services: A Guide for Public Purchasers. (Technical Assistance Publication Series No. 22. DHHS Publication No. (SMA) 98–3173). Rockville, MD: Substance Abuse and Mental Health Services Administration. http://adaiclearinghouse.org/downloads/TAP-22-Contracting-for-Managed-Substance-Abuse-and-Mental-Health-Services-A-Guide-for-Public-Purchasers-113.pdf.
Center for Substance Abuse Treatment. (2006). Definitions and Terms Relating to Co-occurring Disorders. (COCE Overview Paper 1. DHHS Publication No. (SMA) 06–4163). Rockville, MD: Substance Abuse and Mental Health Services Administration and Center for Mental Health Services. https://store.samhsa.gov/shin/content/PHD1130/PHD1130.pdf.
Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13, 1153–1160. https://doi.org/10.1002/wps.20128.
Coughlin, T. A., Long, S. K., Clemans-Cope, L., & Resnick, D. & The Urban Institute. (2013). What Difference Does Medicaid Make? Assessing Cost Effectiveness, Access, and Financial Protection Under Medicaid for Low-Income Adults. Menlo Park, CA: Kaiser Family Foundation. https://kaiserfamilyfoundation.files.wordpress.com/2013/05/8440-what-difference-does-medicaid-make2.pdf.
DeVoe, J. E., Fryer, G. E., Phillips, R., & Green, L. (2003). Receipt of preventive care among adults: Insurance status and usual source of care. American Journal of Public Health, 93, 786–791.
Doescher, M. P., Saver, B. G., Fascella, K., & Franks, P. (2004). Preventive care: Does continuity count? Journal of General Internal Medicine, 19(6), 632–637.
Druss, B. G., Rohrbaugh, R. M., Levinson, C. M., & Rosenheck, R. A. (2001). Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives of General Psychiatry, 58, 861–868.
Druss, B. G., Wang, P. S., Sampson, N. A., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2007). Understanding mental health treatment in persons without mental diagnoses: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 64, 1196–1203. https://doi.org/10.1001/archpsyc.64.10.1196.
Falik, M., Needleman, J., Wells, B. L., & Korb, J. (2001). Ambulatory care sensitive hospitalizations and emergency visits: Experiences of medicaid patients using federally qualified health centers. Medical Care, 39, 551–561.
Health Resources and Services Administration, Maternal and Child Health Bureau. (2013). Usual Source of Care. Women’s Health USA 2013. Rockville, MD. http://mchb.hrsa.gov/whusa13/health-services-utilization/p/usual-source-care.html.
Ho, D., Imai, K., King, G., Stuart, E. A. (2007). Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference. Political Analysis, 15, 199–236. https://doi.org/10.1093/pan/mpl013.
Kaiser Family Foundation. (2012). The Role of Medicaid for People With Behavioral Health Conditions. Menlo Park: CA, Kaiser Family Foundation. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8383_bhc.pdf.
Liaw, W., Petterson, S., Rabin, D. L., & Basemore, A. (2014). The impact of insurance and a usual source of care on emergency department use in the United States. International Journal of Family Medicine, 2014, 842–847. https://doi.org/10.1155/2014/842847.
Little, R. J., & Rubin, D. B. (2000). Causal effects in clinical and epidemiological studies via potential outcomes: Concepts and analytical approaches. Annual Review of Public Health, 21, 121–145.
Mechanic, D., & Bilder, S. (2004). Treatment of people with mental illness: a decade-long perspective. Health Affairs (Millwood), 23, 84–95.
Narrow, W. E., Regier, D. A., Norquist, G., Rae, D. S., Kennedy, C., & Arons, B. (2000). Mental health service use by Americans with severe mental illnesses. Social Psychiatry and Psychiatric Epidemiology, 35, 147–155.
National Committee for Quality Assurance. (2013). Improving Quality and Patient Experience: The State of Health Care Quality 2013. Washington, DC: National Committee for Quality Assurance. http://www.ncqa.org/Portals/0/Newsroom/SOHC/2013/SOHC-web_version_report.pdf.
Paradise, J. (2015). Medicaid Moving Forward. [Kaiser Family Foundation Web site]. Available at http://kff.org/health-reform/issue-brief/medicaid-moving-forward/. Accessed July 28, 2015.
Parks, J., Svendsen, D., Singer, P., Foti, M. E., & Mauer, B. (2006). Morbidity and Mortality in People With Serious Mental Illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. http://www.nasmhpd.org/sites/default/files/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf.
Phelan, M., Stradins, L., & Morrison, S. (2001). Physical health of people with severe mental illness. The BMJ, 322, 443–444.
Quinn, A., & Rosenbach, M. L. (2005). Beyond Coverage: SCHIP Makes Strides Toward Providing a Usual Source of Care to Low-Income Children. Cambridge, MA: Mathematica Policy Research, Inc. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/Downloads/Quinn.pdf.
Rosenbaum, P. R. (1991). Discussing hidden bias in observational studies. Annals of Internal Medicine, 115, 901–990.
Rosenblatt, R. A., Wright, G. E., Baldwin, L. M., Chan, L., Clitherow, P., Chen, F. M., & Hart, L. G. (2000). The effect of the doctor-patient relationship on emergency department use among the elderly. American Journal of Public Health, 90, 97–102.
Rothkopf, J., Brookler, K., Wadhwa, S., & Sajovetz, M. (2011). Medicaid patients seen at federally qualified health centers use hospital services less than those seen by private providers. Health Affairs (Millwood), 30, 1335–1342. https://doi.org/10.1377/hlthaff.2011.0066.
Rubin, D. B. (1997). Estimating causal effects from large data sets using propensity scores. Annals of Internal Medicine, 127(Part 2), 757–763.
Rubin, D. B., & Thomas, N. (1996). Matching using estimated propensity scores: Relating theory to practice. Biometrics, 52, 249–264.
Sayers, S. L., Hanrahan, N., Kutney, A., Clarke, S. P., Reis, B. F., & Riegel, B. (2007). Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. Journal of the American Geriatrics Society, 55, 1585–1591.
Sokal, J., Messias, E., Dickerson, F. B., Kreyenbuhl, J., Brown, C. H., Goldberg, R. W., & Dixon, L. B. (2004). Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. Journal of Nervous and Mental Disease, 192, 421–427.
Sox, C. M., Swartz, K., Burstin, H. R., & Brennan, T. A. (1998). Insurance or a regular physician: Which is the most powerful predictor of health care? American Journal of Public Health, 88, 364–370.
Spatz, E. S., Ross, J. S., Desai, M. M., Canavan, M. E., & Krumholz, H. M. (2010). Beyond insurance coverage: Usual source of care in the treatment of hypertension and hypercholesterolemia. Data from the 2003–2006 National Health and Nutrition Examination Survey. American Heart Journal, 160, 115–121. https://doi.org/10.1016/j.ahj.2010.04.013.
Spatz, E. S., Sheth, S. D., Gosch, K. L., Desai, M. M., Spertus, J. A., Krumholz, H. M., & Ross, J. S. (2014). Usual source of care and outcomes following acute myocardial infarction. Journal of General Internal Medicine, 29, 862–869. https://doi.org/10.1007/s11606-014-2794-0.
Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. Milbank Quarterly, 83, 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x.
Stockbridge, E. L., Philpot, L. M., & Pagán, J. A. (2014). Patient-centered medical home features and expenditures by Medicare beneficiaries. American Journal of Managed Care, 20, 379–385.
Substance Abuse and Mental Health Services Administration. (2014). Results from the 2014 National Survey on Drug Use and Health: Mental Health Findings. (NSDUH Series H-47, HHS Publication No. (SMA) 14–4887). Rockville, MD: Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/NSDUHmhfr2013/NSDUHmhfr2013.pdf.
U.S. Census Bureau. (2015). Urban and Rural Classification. [U.S. Census Bureau Web site]. https://www.census.gov/geo/reference/urban-rural.html. Accessed July 28, 2015.
Weiss, L. J., & Blustein, J. (1996). Faithful patients: The effect of long-term physician-patient relationships on the costs and use of health care by older Americans. American Journal of Public Health, 86, 1742–1747.
Witt, W. P., Fullerton, C. A., Chow, C., Gokhale, M., Naeger, S., Walsh, C., & Karnell, L. (2017). Effect of having a usual source of care on health care outcomes among children with serious emotional disturbance. Academic Pediatrics, 17(1), 45–52.
Witt, W. P., Kahn, R., Fortuna, L., Winickoff, J., Kuhlthau, K., Pirraglia, P. A., & Ferris, T. (2009). Psychological distress as a barrier to preventive healthcare among US women. Journal of Primary Prevention, 30, 531–547. https://doi.org/10.1007/s10935-009-0190-z.
Acknowledgements
We would like to acknowledge Derek Fugh from IBM Watson Health for his programming assistance. We also acknowledge many constructive comments from the staff at SAMHSA and their federal partners and, in particular, comments and assistance from Mitchell Berger.
Funding
This research was supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS) (SAMHSA IDIQ prime contract HHSS283200700029I, task order HHSS28342002T).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No author has any potential conflict of interest or financial support to disclose regarding equity ownership, profit-sharing agreements, royalties, or patents; research or other grants from private industry or closely affiliated nonprofit funds; or support of any kind from pharmaceutical companies.
Rights and permissions
About this article
Cite this article
Fullerton, C.A., Witt, W.P., Chow, C.M. et al. Impact of a Usual Source of Care on Health Care Use, Spending, and Quality Among Adults With Mental Health Conditions. Adm Policy Ment Health 45, 462–471 (2018). https://doi.org/10.1007/s10488-017-0838-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-017-0838-6