Assess the high burden of SDH for patients with severe mental illness

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Two posters presented at GCAP Nexus 2021 examine the high burden of social determinants of health (SDOH) on patients with severe mental illness.

Social determinants of health (SDOH) not only affect health, but also outcomes such as medication adherence. In 2 posters presented at the Academy of Managed Care Pharmacy (AMCP) Nexus 2021 meeting, researchers examined the impact of SDOH on patients with severe mental illness (SMI).

In the first poster,1 which received a Platinum Poster Award from the GCAP, the researchers looked at people with schizophrenia (SCA), type 1 bipolar disorder (BPD), and major depressive disorder (MDD), who were enrolled in Medicaid (MM) commercial and managed health plans from 2016 to 2018 using the Inovalon MORE2 registry.

The analysis examined 1,038,075 patients in commercial plans and 1,234,371 in MM: 55,848 had SCZ, 212,349 had BPD, and 1,762,977 had MDD. Although the mean ages of the BPD and MDD cohorts were similar between commercial and MM plans, patients of a commercial plan who had SCZ were younger than those in the MM cohort (mean age, 40.6 vs. 45.4 years , respectively).

The BPD and MDD cohorts were predominantly female, but the SCZ population was predominantly male. In all cohorts, patients had low Charlson Comorbidity Index scores and the most common chronic disease was hypertension. Patients with MM in all SMI were 3 to 4.5 times more likely to have low income.

“The results show that patients with IMS have important social risk factors that can negatively impact overall health, especially in patients with SCZ insured by Medicaid,” the authors concluded. They noted that further research will need to “explore specific SDOH and patient characteristics associated with disparities in clinical and economic outcomes for each SMI.”

In the second poster,2 the same authors looked specifically at Medicare beneficiaries with the same 3 SMIs. They looked at Medicare and Medicare Advantage (MA) fee-for-service (FFS) again using claim data from 100% Medicare FFS and Inovalon’s MORE2 registry.

There were a total of 2,649,135 beneficiaries screened with more in the FFS (n = 2,342,270) than in the MA (306,865). The vast majority of patients had MDD (89%), followed by BPD (7.6%) and SCZ (3.6%). The mean age for each condition was similar between MA and FFS. Similar to the other poster’s business and MM plans, SCZ patients were more likely to be male, while MDD and BPD patients were more likely to be female.

The researchers also found that SCZ patients were more likely to be a minority compared to BPD and MDD:

  • 25.9% of patients with SCZ were black in FFS and 34.0% in AD; 4.4% were Hispanic in FFS and 10.2% in MA.
  • 13.2% of BPD patients were black in FFS and 19.0% in AD; 3.1% were Hispanic in FFS and 8.0% in MA.
  • 8.2% of patients with MDD were black in FFS and 13.3% in AD; 2.4% were Hispanic in FFA and 9.3% in MA.

Additionally, while MDD patients were primarily Medicare eligible because of their age, SCZ and BPD patients were primarily qualified because of their disability. Recipients with SCZ were also more likely to be doubly eligible for Medicaid, with up to 83% eligible for both, compared to as much as 70% of BPD patients and just 42% of MDD patients.

Overall, the burden of SDOH among Medicare beneficiaries with IMS is high, but it is especially high for patients with SCZ. Patients with SCZ were also less likely to be married or own their own home. They were more likely to live alone, to be below the federal poverty line, to live in an area of ​​high unemployment, to have a high school diploma or less, not to own a vehicle and to speak poorly. or no English at all.

“Understanding the impact of SDOH on health care use and Medicare outcomes in the vulnerable population is critical, which can exacerbate their heavy burden of comorbidity,” the authors wrote. “If left untreated, social risk factors can lead to poorer health outcomes and higher costs for the Medicare population with IMS. “

The references

1. Mohammadi I, Teigland C, Agatep B, Hadzi Boskovic D, Kim S. The high prevalence of social determinants of health worsens the burden of disease in patients with severe mental illness. Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, CO. Abstract F19.

2. Teigland C, Mohammadi I, Agatep B, Hadzi Boskovic D, Kim S. Medicare beneficiaries with severe mental illness (SMI) have a high prevalence of social determinants of health (SDOH). Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, CO. Abstract F20.


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