Schizophrenia (Sz), bipolar disorder (BD), and major depressive disorder (MDD) are associated with elevated burden and cost of care. Compared to medical patients, far less is known about the association between patient activation, health, service utilization and cost among mental health (MH) patients.
Medicaid patients (N=67) from five community clinics completed the Patient Activation Measure for Mental Health (PAM-MH) and the Colorado Symptom Index (CSI). Survey results were linked to administrative claims. Participants’ primary MH diagnoses were Sz (n=22), BD (n=28), & MDD (n=17).
16% had high activation (level IV), 39% were at level III and the balance (45%) had poor activation. The sample showed elevated CSI* (mean: 37.2 ±10.9, p<0.01) and elevated medical costs** ($19,682 pmpy) compared to average levels. PAM was inversely correlated (r = - 0.27) to CSI, hospital based (CMHC) clinic visits (r= - 0.22) and had modest, but directionally correct correlation with total medical costs (r= - 0.15) and total healthcare costs (r= - 0.11). PAM score was also inversely correlated to utilization of psychiatric services: CMHC, inpatient admissions, and ER utilization (r = - 0.18; r= - 0.13; r = -0.13 respectively).
These interim analyses lend support to the relationship between PAM-MH and healthcare service utilization and cost. Nearly half had low activation and high symptom burden leading to elevated cost of care. Directionally correct signals suggest that when completed, the full study sample may support use of the PAM to identify MH patients in greatest need of intervention.