Mental Illness and Health Disparities – A Study of Quality Care

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Mental Illness
Mental Illness and Health Disparities – A Study of Quality Care

The members of NCQA’s Research Team have some news to share: Our study on health care for people with mental illness has been published in the American Journal of Managed Care. Disparities in Diabetes and Hypertension Care for Individuals With Serious Mental Illness (SMI) examines the quality of diabetes and hypertension care for Medicaid and Medicare enrollees with SMI.

The team started with the premise that people with SMI are more likely to have diabetes and hypertension and are more likely to die earlier from these diseases than the rest of the population. The study notes that people with SMI—including schizophrenia, bipolar disorder and major depression—are at higher risk of chronic physical health conditions. This is partly due to poor diet, psychiatric medication side effects and lack of access to primary care.

Study results show that roughly 15% of people with schizophrenia and 18% of people with major depression have diabetes, compared with 9% of the general population. And nearly 40% of people with bipolar disorder and 48% of people with major depression have hypertension, compared with 30% of the general population.


There is substantial room for improvement on almost all HEDIS diabetes and hypertension measures for individuals with SMI, who contribute to disproportionately high health care costs. The study found that rates of diabetes and hypertension care for people with SMI were 15–40 percentage points lower than the national averages for the general population in Medicaid plans. Disparity in care is driven primarily by the lack of utilization of ambulatory medical care.

Findings and Recommendations

Health plans can use NCQA’s diabetes and hypertension outcome measures developed for this study to evaluate integration efforts and to monitor care for this vulnerable population. Plans should monitor quality of care to reduce disparities, and may want to target care coordination and integration of primary and behavioral health care to improve care.

The authors conducted this work under contract to the Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (HHS) (HHSP23320100019WI, HHSP23337001T). Funding was provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), HHS. Views and opinions expressed are those of the authors and do not necessarily reflect the views, opinions, or policies of ASPE, SAMHSA, or HHS.

See the full published report in the American Journal of Managed Care here.

Junqing Liu
Junqing Liu is a Research Scientist at NCQA. Dr. Liu leads quality measure development and testing efforts in the area of behavioral health. She serves as a project director and researcher on several federally funded child and adult behavioral health measurement projects at NCQA. As the lead of NCQA’s behavioral health measures, Dr. Liu guides the re-evaluation and updates of HEDIS behavioral health measures. Dr. Liu’s research focuses on access to mental health services, evidence-based treatment for behavioral health problems, and child welfare services. Prior to joining NCQA, Dr. Liu was a research assistant professor at University of Maryland School of Social Work and conducted the evaluation of a federally funded research project on the implementation of evidence-based practices in child welfare systems in six states. She holds a Ph.D. and a Master in Social Work from University at Albany, State University of New York.

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