The Medicaid program spends $26.4 billion on mental health care, yet underuse and misuse of recommended treatment and associated adverse and costly clinical events are common. Major gaps persist in our knowledge of how to convert public health insurance into guideline-concordant mental health care, care that is consistent with evidence-based treatment guidelines. The proposed Career Development Award would allow Dr. Burns to supplement her expertise in health policy and economics with the clinical, methodological, and additional economic training necessary to lead clinically and policy-relevant research on the economics of public health insurance design for adults with serious mental illness (SMI). The specific training aims are: 1) to develop knowledge of the natural history and treatment of SMI and the clinical- and systems- level challenges to providing guideline-consistent treatment to very low-income adults with SMI;2) to expand knowledge about the economic incentives created for patients, clinicians, and public mental health authorities by specific features of public health insurance design;3) to acquire methodological expertise in evaluating the impact of public health insurance policies on the receipt of guideline-concordant mental health care using quasi-experimental designs and administrative data. Dr. Burns will be guided by her mentor, Stephen Soumerai, ScD, and co-mentors Jack Burke, MD, MPH, and Haiden Huskamp, PhD. Her career development plan includes coursework and guided study with: Dr. Burke on clinical issues and evidence-based care for SMI treatment;Dr. Soumerai, on the design and analysis of quasi-experimental mental health policy research using claims-based measures of guideline-concordant care;and Dr. Huskamp, on the economics of health insurance and mental health care policy. Dr. Burns will use the knowledge and skills acquired through these career development activities to conduct three studies. The first study examines the extent to which simplification of state Medicaid enrollment and renewal requirements influences Medicaid or private health insurance coverage for adults with SMI and other disabilities. The second evaluates the effects of eliminating annual visit limits for psychotherapy and counseling that is provided outside of a community mental health center on mental health care use and cost including receipt of guideline-concordant care for publicly insured adults with SMI. The third assesses the extent to which changes in the generosity of Medicaid psychiatrist fees are associated with changes in and beneficiary use of, outpatient psychiatrist and non-psychiatrist services, and care process indicators of outpatient mental health care adequacy. The proposed K01 Award will provide Dr. Burns with the training, mentoring, and resources needed to lead independent research in mental health care policy, focusing on the links between the economics of public health insurance, public mental health care delivery, and mental health treatment quality for low-income adults with SMI.

Public Health Relevance

The proposed project is relevant to public health in its focus on state-level policies that have the potential to influence mental health care access and quality for adults with serious mental illness.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Scientist Development Award - Research & Training (K01)
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Mental Health Services in Non-Specialty Settings (SRNS)
Program Officer
Hill, Lauren D
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University of Wisconsin Madison
Public Health & Prev Medicine
Schools of Medicine
United States
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Burns, Marguerite E; Huskamp, Haiden A; Smith, Jessica C et al. (2016) The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness. Med Care 54:868-77
Burns, Marguerite E; Wolfe, Barbara L (2016) The Effects of the Affordable Care Act Adult Dependent Coverage Expansion on Mental Health. J Ment Health Policy Econ 19:3-20
Adams, Alyce S; Soumerai, Stephen B; Zhang, Fang et al. (2015) Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression. Clin Ther 37:597-609
Burns, Marguerite E (2015) State discretion over Medicaid coverage for mental health and addiction services. Psychiatr Serv 66:221-3
Wherry, Laura R; Burns, Marguerite E; Leininger, Lindsey Jeanne (2014) Using self-reported health measures to predict high-need cases among Medicaid-eligible adults. Health Serv Res 49 Suppl 2:2147-72
Burns, Marguerite E; Dague, Laura; DeLeire, Thomas et al. (2014) The effects of expanding public insurance to rural low-income childless adults. Health Serv Res 49 Suppl 2:2173-87
Burns, Marguerite E; Busch, Alisa B; Madden, Jeanne M et al. (2014) Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar I disorder among dual beneficiaries. Psychiatr Serv 65:323-9
Burns, Marguerite E; O'Hara, Brett J; Huskamp, Haiden A et al. (2012) Uninsurance and its correlates among poor adults with disabilities. J Health Care Poor Underserved 23:1630-46