The Effects of an Enhanced Primary Care Model for Patients with Serious Mental Illness on Emergency Department Utilization

Connor Belson
Brian Sheitman
Beat Steiner
Journal Article
May 2020

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.

Posted to The Playbook on
Population Addressed
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • Can an enhanced primary care approach that integrates behavioral and physical health care reduce emergency department utilization for Medicaid patients with serious mental illness?
  • How long does it take for individuals with serious mental illness enrolled in an integrated, patient-centered medical home to experience decreased emergency department usage?
Level of Evidence
What does this mean?