Individuals with serious mental illness (SMI) have high preventable emergency department (ED) usage, often due to poorly managed chronic medical conditions. A North Carolina primary care center implemented a patient-centered medical home for Medicaid patients with SMI to address the complex needs of this population, with enhanced primary care and behavioral health care delivered in the same location.
A study of this North Carolina-based program found that participating in the enhanced primary care model led to reductions in ED usage after roughly three to four years of program enrollment. Notably, after this length of enrollment, the rate of ED visits declined for patients with physical health complaints and multiple physical chronic conditions. These changes only occurred after patients had been established at the medical home. Some patients experienced an initial rise in ED visits after enrollment, and the reasons for this are not totally clear, but may be due to an increased awareness of health issues after establishing care. Health systems implementing integrated care approaches and tracking changes in ED visits may need to use a multi-year timeline to assess the impact of enhanced primary care approaches for this population.