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An Economic Evaluation of Severe Mental Health Disorder Treatment Options
An Economic Evaluation of Severe Mental Health Disorder Treatment Options
Gillian Arleth
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Mental illnesses are more common than cancer, heart disease, and diabetes. 1 Although they affect nearly one in five adults in the US, the question remains: are those suffering from mental illness effectively treated? 2 Many researchers are evaluating the success of mental health treatment options, including UNC-Chapel Hill professor, Dr. Domino. Working in the Department of Health Policy and Management, Dr. Domino investigates the efficacy of healthcare policies that focus on low income and disabled populations. It wasn’t until college that she found her interest in health policy. Originally a piano performance major, she began taking courses in health policy and realized her true interests. In graduate school, Dr. Domino worked with mental health policies and economics. She has continued researching mental health economics and recently investigated the efficacy of primary care based medical homes in her article titled Through the Looking Glass: Estimating Effects of Medical Homes for People with Severe Mental Illness. Her review analyzes the impact of enhancements added to primary care facilities on those with severe mental illnesses. Dr. Domino states “In a primary care based medical home, a team maintains overall responsibility for an individual’s health care, including any coordination needed with specialty providers”. 3 Medical homes have the potential to improve outcomes for patients with severe mental illness. These facilities are characterized by more communication between physicians and mental health care
providers, the development of understanding and trusting relationships between patients and caregivers, and patients are more likely to adhere to medication recommendations. Dr. Domino saw the need for more research to determine if these are actual advantages especially because of the diversity in responses to treatment. She also recognized the significance of this research because mental illness disproportionately impacts people on Medicaid. Attentively monitoring treatment options could have far reaching impacts on the large portion of the population affected by mental disorders. The study focused on the effect of medical homes on patients enrolled in Medicaid and diagnosed with one of three different severe mental illnesses: schizophrenia, bipolar disorder, and major depressive disorder. Dr. Domino chose both schizophrenia and bipolar disorder because of their characterization as severe mental health disorders. However, opinions differ in regards to major depressive disorder’s similar categorization. Dr. Domino chose to investigate major depressive disorder because of the abundant evidence relating
Dr. Marisa Domino
Figure 1: The study showed an increase in medication adherence for all three groups. Image courtesy of Creative Commons.
the disorder to inability to hold a job and worsening personal relationships. The sample included those diagnosed with a severe mental health disorder who were not dual-enrolled in Medicare or a nursing home. 4 The study revealed positive associations between patient residence at medical homes and access to primary care along with specialty mental health care, increased medication adherence, and a slight decrease in emergency department use. These results were consistent across the three disorders. Emergency department models revealed that visits were more frequent in months prior to enrollment, and during the first month after enrollment. Medication adherence also shows a shift after the first month of being enrolled in a medical home. The data indicates lower levels of medication adherence during months prior to enrollment, while consequently, an increase in adherence was observed in the first month receiving treatment at the medical home. While there are clearly many benefits of medical homes, the drawback of higher Medicaid expenditures remains. Data reveals that Medicaid costs for patients enrolled in medical homes are estimated to be 27-37 percent higher than the non-enrolled control group. The use of medical homes and preventative screenings in individuals with major depressive disorder were associated. However, no association was found for patients with schizophrenia or bipolar disorder. Dr. Domino offers a possible explanation by speculating that major depression is a very common diagnosis, so primary care providers are more comfortable and experienced in treating them. The increase in treatment experience could be the reason why the patients with a major depressive disorder are receiving more preventative screenings which could be associated with a higher quality of care. The fact that preventive screenings were not equal across the disorders speaks to another important aspect of Dr. Domino’s research: heterogeneity. Heterogeneity refers to different sources of variation which in this study could be different responses to treatment or different types of treatment received. Dr. Domino opines that this indicates that medical homes could tailor their services based on the patient and their level of psychiatric functioning. Recently, Dr. Domino has expanded on her research and investigates the effectiveness of policy changes happening right here in North Carolina. The Medicaid system in North Carolina is currently undergoing transformations once again. The changes will put into place managed care plans to help direct individualized care for those with Medicaid. Dr. Domino is working with the state to evaluate this transformation in the Medicaid program. She is also working on research investigating patient-centered medical homes for care by looking into accountable care organizations and creating financial mechanisms to improve quality, as well as, reduce costs. Dr. Domino’s research marks her as a pioneer in the medical field as it is critical to continuously evaluate treatment options for disorders that are so ubiquitous. By continuing this research, she is finding more ways to assess the effectiveness of health care policies put in place to help underrepresented populations.
References
1. (nd) Mental Illnesses Are More Common Than the Big Three https://www.comphc.org/yakima-valley-mentalhealth-blog-detail.php?blog_id=5 (accessed February 5th, 2020). 2. (nd) National Institute of Mental Health https:// www.nimh.nih.gov/health/statistics/mental-illness. shtml (accessed February 5th, 2020). 3. Domino, M. E; Kilany, M; Wells, R; Morrissey, J. P. HSR. 2016, 52(5), 1858-1800. https://www.ncbi.nlm. nih.gov/pmc/articles/PMC5583299/ 4. Interview with Marisa E. Domino, Ph.D. 02/03/20.
