title: Through the Looking Glass: Estimating Effects of Medical Homes for People with Severe Mental Illness.
abstract: To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques.
  
  
  
  Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility.
  
  
  
  We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses.
  
  
  
  Data were received from the Carolina Cost and Quality Initiative.
  
  
  
  The four estimation techniques consistently revealed generally positive associations between medical homes and access to primary care, specialty mental health care, greater medication adherence, slightly lower emergency room use, and greater expenditures. These findings were consistent across all three major severe mental illness diagnostic groups. Some heterogeneity in effects were noted, especially in preventive screening.
  
  
  
  Expanding access to primary care-based medical homes for people with severe mental illness may not save money for insurance providers, due to greater access for important outpatient services with little cost offset. Health services research examining more of the treatment heterogeneity may contribute to more realistic projections about medical homes outcomes.
authors.affiliation: Department of Health Policy and Management, The Gillings School of Global Public Health, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Marisa Elena
authors.initials: ME
authors.lastname: Domino
authors.affiliation: American Institutes for Research, Chapel Hill, NC.
authors.forename: Mona
authors.initials: M
authors.lastname: Kilany
authors.affiliation: The University of Texas School of Public Health, Houston, TX.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wells
authors.affiliation: Department of Health Policy and Management, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Morrissey
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000628:therapy; D003865:Major Depressive Disorder / Q000628:therapy; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000628:therapy; D012959:Socioeconomic Factors; D014481:United States; D016903:Drug Monitoring
keywords: Medicaid; Medical home; mental illness