Changes in Hospital Utilization Among Seriously Mentally Ill Patients Following Enrollment in an Integrated Primary and Behavioral Health Care Program.

OBJECTIVES: Integrated primary and behavioral health care models are emerging to improve access to care; however, the effect they have on utilization and expenditure has yet to be studied.

METHODS: A retrospective, longitudinal review of all patients (N = 343; 97% Medicaid) enrolled in our primary and behavioral health care program looked at hospital utilization up to a year before and after enrollment and estimated spending from Medicaid reimbursement data.

RESULTS: There was a significant decrease in emergency department (ED) visits per person before enrollment vs after enrollment (2.39 vs 1.88, P = .009) with a decrease in those classified as high ED utilizers (four or more times in a year) from 22% to 16%, respectively (P = < .001). 'here was no change in inpatient admissions or length of stay. Medicaid saved $701.89 per client while costing the hospital $981.93 per client.

CONCLUSION: Integrated health care may decrease ED utilization for clients with a serious mental ill- ness (SMI) while increasing savings for Medicaid and reducing hospital revenue.