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

Knitter, Alexandra C.; Murugesan, Manoradhan; Saulsberry, Loren; Wan, Wen; Nocon, Robert S.; Huang, Elbert S.; Bolton, Joshua; Chin, Marshall H.; Laiteerapong, Neda

doi:10.1097/mlr.0000000000001766

Cited by 2 publications

(2 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings differ from a previous study of Medicaid-covered individuals with SMI in North Carolina that found no difference in inpatient and ED utilization for FQHC patients vs. patients with other primary medical homes [ 10 ]. However, other studies of the general FQHC population have similarly found increases in ED visits and decreases in hospitalizations [ 34 , 35 ]. Expansion of Medicaid coverage has been associated with increased ED utilization, [ 36 – 38 ] and one hypothesis for the phenomenon is that greater access to primary care may increase utilization across care settings, including the ED [ 36 ].…”

Section: Discussionmentioning

confidence: 95%

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

Myong,

Yang,

Behr

et al. 2024

BMC Health Serv Res

View full text Add to dashboard Cite

Background Federally Qualified Health Centers (FQHCs) are a critical source of care for medically underserved populations and often serve as medical homes for individuals with serious mental illness (SMI). Many FQHCs provide mental health services and could facilitate access to mental health treatment within and outside of FQHCs. This study compared mental health care utilization and acute care events for adult Medicaid enrollees with SMI who receive care at Federally Qualified Health Centers (FQHCs) vs. other settings. Methods This study used the 2015–2016 Massachusetts All-Payer Claims Database to examine outpatient mental health care and acute care events for 32,330 Medicaid adults, ages 18–64 and with major depressive, bipolar, or schizophrenia spectrum disorders (SSD), who resided in FQHC service areas and received care from FQHCs vs. other settings in 2015. Multivariable linear regressions assessed associations between receiving care at FQHCs and outpatient mental health visits, psychotropic medication fills, and acute care events in 2016. Results There were 8,887 (27.5%) adults in the study population (N = 32,330) who had at least one FQHC visit in 2015. Those who received care at FQHCs were more likely to have outpatient mental health visits (73.3% vs. 71.2%) and psychotropic medication fills (73.2% vs. 69.0%, both p < .05), including antidepressants among those with depressive disorders and antipsychotics among those with SSD. They were more likely to have ED visits (74.0% vs. 68.7%), but less likely to be hospitalized (27.8% vs. 31.9%, both p < .05). However, there was no significant difference in the likelihood of having an acute psychiatric hospitalization (9.5% vs. 9.8%, p = .35). Conclusions Among Medicaid enrollees with SMIs who had access to care at FQHCs, those receiving care at FQHCs were more likely to have outpatient mental health visits and psychotropic medication fills, with lower rates of hospitalization, suggesting potentially improved quality of outpatient care. Higher ED visit rates among those receiving care at FQHCs warrant additional investigation.

show abstract

Section: Discussionmentioning

confidence: 95%

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

Myong,

Yang,

Behr

et al. 2024

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…We were surprised to see the lack of contextualization in the publication of the methodologically strong study by Knitter et al1 comparing the quality of care for adults with Medicaid insurance and Type 2 diabetes in Federally Qualified Health Centers (FQHCs) and other settings. So much has changed in the decade since the data were collected for this study.…”

mentioning

confidence: 99%

Letter to the Editor

Cook

Stange

2023

Medical Care

View full text Add to dashboard Cite

We were surprised to see the lack of contextualization in the publication of the methodologically strong study by Knitter et al 1 comparing the quality of care for adults with Medicaid insurance and Type 2 diabetes in Federally Qualified Health Centers (FQHCs) and other settings. So much has changed in the decade since the data were collected for this study. While opportunities undoubtedly exist to further support FQHCs in caring for people with diabetes, findings from 10 years ago are of limited relevance for current clinical or policy decisionmaking.In the past decade, patients seeking care in FQHCs have grown from 21.1 million (2012) to over 30 million. 2 Since 2010, FQHC staff has increased by more than 120,000, with many of these positions dedicated to chronic disease care, including clinical support staff, Community Health Workers, and behavioral health professionals. 3,4 During this same period, care delivery within FQHCs has changed dramatically, with initiatives specifically designed to improve care processes and patient outcomes for patients with chronic disease. In addition to the ACA Medicaid expansion noted by the authors, major transformative initiatives include Patient-Centered Medical Home certification, 5 Quality reporting (eg, Meaningful Use), and the Diabetes Quality Improvement Initiative. 6 Nationally reported data suggest that outcomes for FQHC patients with diabetes surpass non-FQHC care. In 2020, 45.4% of Medicaid HMO patients had poor HbAq1c control (HEDIS), compared with 35.60% of FQHC patients (UDS data), and other studies show a wide range of high-value, high-quality care at FQHCs. [7][8][9] We understand that complex research can take many years to advance, and we passionately agree with the authors that it is critical to invest in Medicaid programs for patients with diabetes, including those in FQHCs. However, we believe that it also is important to prominently situate research in the time in which the data were collected.

show abstract

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

Cited by 2 publications

References 31 publications

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

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

Letter to the Editor

Contact Info

Product

Resources

About