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Disparities in Diabetes and Hypertension Care for Individuals With Serious Mental Illness
Junqing Liu, PhD; Jonathan Brown, PhD; Suzanne Morton, MPH; D.E.B. Potter, MS; Lisa Patton, PhD; Milesh Patel, MS; Rita Lewis, MPH; and Sarah Hudson Scholle, DrPH
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Disparities in Diabetes and Hypertension Care for Individuals With Serious Mental Illness

Junqing Liu, PhD; Jonathan Brown, PhD; Suzanne Morton, MPH; D.E.B. Potter, MS; Lisa Patton, PhD; Milesh Patel, MS; Rita Lewis, MPH; and Sarah Hudson Scholle, DrPH
This study highlights disparities in care for diabetes and hypertension for individuals with serious mental illness compared with the general Medicaid and Medicare populations.
Although it is difficult to draw broad conclusions from only 3 health plans, performance variations may reflect differences in plan capacity to manage care for this population. Medicaid & Medicare D-SNPs are designed to coordinate care for dual-eligible populations with complex health conditions. At least 1 other study found that dual-eligible enrollees were more likely to receive diabetes testing than Medicaid-only enrollees.22 Performance differences could reflect that health plans serve different populations and operate in different state contexts, in terms of service systems and available community resources. Utilization of ambulatory care corresponded to measure performance, suggesting that getting people into care is key to managing conditions. Health plans may identify individuals with SMI who are at risk for poor outcomes simply by monitoring the use of ambulatory physical healthcare.  

Previous studies using claims data, clinical registries, and information collected at mental health clinics have found poor management of diabetes and hypertension among the SMI population.10,22,23 This study’s findings provide a snapshot of the quality of care for individuals with SMI who are enrolled in comprehensive health plans, using data collected from health records. This study also used common measures for diabetes and hypertension care for direct comparison with care quality for the general plan population. Although these plans were responsible for physical and behavioral health benefits, individuals with SMI had poor management of diabetes and hypertension. Given the side effects of psychiatric medications, providers should routinely monitor the comorbid medical conditions of SMI populations.  

Limitations

This pilot study was limited to health plans, and the sample size for each plan was modest due to variation in the prevalence of members with SMI and diabetes or hypertension. As other plans use these or similar measures, it will be important to compare their performance with this study’s findings and to examine sources of performance variations. 

CONCLUSIONS

This study highlights disparities in care for diabetes and hypertension for individuals with SMI who are enrolled in Medicaid and Medicare managed care plans. Although health plans demonstrated variation in measure performance, the average on most indicators was much lower for the SMI population than for the general population. Measures developed for this study fill critical gaps in quality measurement for the SMI population. Following pilot testing, they were endorsed by the National Quality Forum and are now available for health plans, state agencies, and other organizations to monitor quality of care for the SMI population. They may also be useful for ongoing healthcare delivery system demonstrations and reforms toward improving care for this population.

Author Affiliations: National Committee for Quality Assurance (JL, SM, SHS, RL, MP), Washington, DC; Mathematica Policy Research, Inc (JB), Washington, DC; Office of the Assistant Secretary for Planning and Evaluation (DEBP), Washington, DC; Substance Abuse and Mental Health Services Administration (LP), Rockville, MD. 

Source of Funding: The authors conducted this work under contract to the Office of the Assistant Secretary for Planning and Evaluation (ASPE), US Department of Health and Human Services (HHS) (HHSP23320100019WI, HHSP23337001T). Funding was provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), HHS. Views and opinions expressed are those of the authors and do not necessarily reflect the views, opinions, or policies of ASPE, SAMHSA, or HHS.

Author Disclosures: Drs Liu and Scholle, Ms Morton, Mr Patel, and Ms Lewis, work for National Committee for Quality Assurance, a nonprofit organization that develops and maintains quality measures. The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 

Authorship Information: Concept and design (JL, JB, MP, RL, DEBP, LP, SHS); acquisition of data (JL, JB, RL, DEBP, SHS); analysis and interpretation of data (JL, JB, SM, MP, RL, SHS); drafting of the manuscript (JL, JB, SM, MP, RL, SHS); critical revision of the manuscript for important intellectual content (JL, JB, SHS); statistical analysis (JB, SM); obtaining funding (JB, DEBP, LP, SHS); administrative, technical, or logistic support (MP, RL, DEBP, LP). 

Address Correspondence to: Junqing Liu, PhD, National Committee for Quality Assurance, 1100 13th St NW, Ste 10000, Washington, DC 20005. E-mail: liu@ncqa.org. 
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