More than 10 million adults in the United States have serious mental illness (SMI) and 26 percent are covered by Medicaid. Today, states are investing in and creating new care delivery models to support these individuals, including behavioral health homes, and are employing a new health care workforce – peer navigators – to support these initiatives.
A patient-centered approach is essential for state health policymakers to effectively address SMI, according to experts, and new research that includes several studies funded by the Patient Centered Outcomes Research Institute, offers important findings. These studies explore research outcomes, selected with the input of patients, such as patient activation and quality of life.
- A study by researchers at the University of Pittsburgh Medical Center’s Center for High-Value Health Care focused on Medicaid enrollees with SMI who received care at community mental health centers that used a behavioral health home model. Researchers compared patient self-directed care, which included a web portal that helped patients learn about their conditions, with provider-supported care that involved aid from a registered nurse. Results indicated both approaches were associated with gains in patient activation, a term describing the knowledge, skills, and confidence patients have in managing their own health and health care. Researchers wrote, “Our findings suggest that payers [e.g., Medicaid] may be able to leverage their unique relationship with community mental health providers to improve outcomes for patients, and to integrate physical health and wellness support into their existing care delivery settings.”
- Another study examined the impact of peer navigators on the treatment of Latinos with SMI, a population that receives treatment at lower rates than their white counterparts with SMI. The Illinois-based study compared groups who received just integrated physical and mental health services to a group that received integrated care plus the assistance of peer navigators. Researchers found better outcomes in the peer navigator-assisted group, including increases in the number of patients who scheduled and appeared for appointments, as well as improvements in empowerment, recovery, and quality of life scores. “Individuals in recovery can be trained in the discrete skills that comprise PNP [peer navigator programs] to help peers identify and address their health goals,” researchers reported. They also found that culturally-competent peer navigators could address the unique needs of Latino patients. “Research shows that [patient navigator] services should include strategies that address issues leading to disparities: language, values, immigration, accessibility, and insurance coverage.
The National Academy for State Health Policy’s patient-centered research workgroup, made up of state policymakers from a range of agencies, met recently to review these and other new studies addressing SMI and to discuss the potential policy implications of this research. The workgroup recognized the importance of patient-centered research, especially for the SMI population for whom outcome measures such as patient activation, empowerment, and quality of life are critical. While the positive findings on outcomes, such as patient activation, may encourage states to innovate by pursuing federally-funded demonstration projects, other policy decisions involving Medicaid or which services would be covered require a stronger level of evidence, including information on other relevant outcomes.
Policymakers indicated the need for additional evidence that confirmed cost savings and return on investment before implementing these new models. For example, do increases in patient activation result in decreased health care costs or reductions in hospitalizations and emergency room admissions? Do they lead to improved health outcomes in these individuals? A 2015 study that assessed patient activation in relation to health outcomes and costs found that higher activation scores were associated with better outcomes, including healthy behaviors and greater use of prevention screening, as well as lower costs. With additional analysis of the impact on costs and utilization, patient-centered outcomes research offers policymakers important and valued information to guide their decision-making.