OBJECTIVES: People with serious mental illnesses (SMI), including schizophrenia, bipolar disorder, and major depression, experience early mortality, partly due to comorbid physical health conditions such as diabetes and hypertension. This study examined the quality of diabetes and hypertension care for Medicaid and Medicare enrollees with SMI. STUDY DESIGN: We conducted a retrospective analysis of medical records and claims data from 3 health plans: a Medicaid plan for disabled adults, a Medicaid plan for low-income adults, and a Special Needs Plan for individuals dually enrolled in Medicaid and Medicare. The study population included 258 adults with SMI and diabetes and 241 adults with SMI and hypertension. METHODS: Existing quality measures for diabetes and hypertension from the Healthcare Effectiveness Data and Information Set (HEDIS) were adapted and applied to the SMI population for the 2012 calendar year. The rates of diabetes care and hypertension control for people with SMI were compared with national averages for Medicaid and Medicare managed care plans to examine disparities in care. RESULTS: Adults with SMI receive poor-quality care for diabetes and hypertension. Depending on the health plan, performance on the diabetes care and hypertension control HEDIS measures was 14 to 49 percentage points lower among the SMI population than the general Medicaid and Medicare populations. CONCLUSIONS: Findings highlight disparities in care for individuals with SMI compared with the general Medicaid and Medicare populations. Health plans demonstrated substantial room for improvement on almost all diabetes and hypertension HEDIS measures for the SMI population.
OBJECTIVES:People with serious mental illnesses (SMI), including schizophrenia, bipolar disorder, and major depression, experience early mortality, partly due to comorbid physical health conditions such as diabetes and hypertension. This study examined the quality of diabetes and hypertension care for Medicaid and Medicare enrollees with SMI. STUDY DESIGN: We conducted a retrospective analysis of medical records and claims data from 3 health plans: a Medicaid plan for disabled adults, a Medicaid plan for low-income adults, and a Special Needs Plan for individuals dually enrolled in Medicaid and Medicare. The study population included 258 adults with SMI and diabetes and 241 adults with SMI and hypertension. METHODS: Existing quality measures for diabetes and hypertension from the Healthcare Effectiveness Data and Information Set (HEDIS) were adapted and applied to the SMI population for the 2012 calendar year. The rates of diabetes care and hypertension control for people with SMI were compared with national averages for Medicaid and Medicare managed care plans to examine disparities in care. RESULTS: Adults with SMI receive poor-quality care for diabetes and hypertension. Depending on the health plan, performance on the diabetes care and hypertension control HEDIS measures was 14 to 49 percentage points lower among the SMI population than the general Medicaid and Medicare populations. CONCLUSIONS: Findings highlight disparities in care for individuals with SMI compared with the general Medicaid and Medicare populations. Health plans demonstrated substantial room for improvement on almost all diabetes and hypertension HEDIS measures for the SMI population.