Are There Performance Advantages Favoring Federally Qualified Health Centers in Medical Home Care for Persons with Severe Mental Illness?

Mental health care use and quality among Medicaid adults with serious mental illness receiving care at Federally Qualified Health Centers vs. other settings

“…Individuals with vs. without SMI are also more likely to have incomes below the federal poverty level, more likely to be uninsured or have Medicaid insurance, and are at increased vulnerability to social determinants of health [ 4 – 9 ]. Federally Qualified Health Centers (FQHCs) are a potential care setting for people with SMI to receive high-quality, accessible care [ 10 , 11 ], but there is limited information on care patterns for individuals with SMI who receive care from FQHCs compared with other settings.…”

“…FQHCs provide care to underserved areas and populations, and the majority of patients at FQHCs have incomes at or below 200% of the federal poverty level [ 12 ]. FQHCs are also required to offer comprehensive primary care with enabling services, such as transportation, language interpretation, care coordination and other non-clinical services that aim to increase access to health care [ 10 ]. In addition, almost 90% of FQHCs provide on-site mental health services per a 2019 national survey, [ 13 ] although the types of services offered and availability of providers vary and may vary across delivery sites for a given health center [ 13 , 14 ].…”

“…There is little existing evidence, however, on differences in utilization patterns and quality of care for individuals with SMI who receive care at FQHCs versus other care settings. A study of the North Carolina Medicaid population found no difference in emergency department (ED) use and medication adherence for adults with SMI in FQHC medical homes compared to other medical homes [ 10 , 19 ]. In this study, we used the Massachusetts All-Payer Claims Dataset (APCD) to examine differences in outpatient mental health care, including mental health visits and psychotropic medication use, and acute care events, including ED visits and hospitalizations, among adult Medicaid enrollees with SMI who reside in FQHC service areas and receive care at FQHCs vs. other outpatient settings.…”

Quality of Care for US Adults With Medicaid Insurance and Type 2 Diabetes in Federally Qualified Health Centers Compared With Other Primary Care Settings

“…Prior studies comparing primary care delivered at FQHC and non-FQHC settings have found that FQHCs provide similar 9 or more 10 preventive care for a general population and similar care for patients with serious mental illness. 11 Other studies have found that patients receiving primary care at health centers may have lower use and spending than similar patients at other sites of primary care, [12][13][14][15] but may have higher emergency department (ED) utilization. 14,16,17 While these studies suggest that overall quality of primary care in FQHCs is comparable or superior to other settings, they are limited in how they address the inherent demographic and clinical diversity of patients from one setting to another, as well as the quality of care on a national level.…”

“…Prior studies comparing primary care delivered at FQHC and non-FQHC settings have found that FQHCs provide similar9 or more10 preventive care for a general population and similar care for patients with serious mental illness 11. Other studies have found that patients receiving primary care at health centers may have lower use and spending than similar patients at other sites of primary care,12–15 but may have higher emergency department (ED) utilization 14,16,17.…”