Medicare Beneficiaries with Serious Mental Illness Have High Prevalence of Social Determinants of Health

A study assessed social determinants of health (SDOH) characteristics among Medicare Fee-for-Service (FFS) and Medicare Advantage (MA) beneficiaries with schizophrenia (SCZ), bipolar I disorder (BP I), and major depressive disorder (MDD) between 2016 to 2018. The results were published as a poster at AMCP Nexus 2021.

This retrospective observational study consisted of 2,649,135 patients (FFS: 2,342,270; MA: 306,865) aged ≥18 with newly diagnosed SCZ, BP I, or MDD. SDOH were identified at the neighborhood level using nine-digit zip codes.

The mean ages of patients with MDD, BP I, and SCZ were 70.6 (FFS) and 69.6 years (MA), 56.3 and 56.8, and 56.5 and 57.1, respectively. The subgroup of patients with SCZ was 55% male, while the BP I and MDD subgroups skewed female. In the SCZ group compared with the BP I and MDD groups, there were higher proportions of Black patients (FFS, 25.9% versus 13.2% and 8.2%, respectively; MA, 34.0% vs. 19.0% and 13.3%) and Hispanic patients (FFS, 4.4% vs. 3.1% and 2.4%; MA, 10.2% vs. 8.0% and 9.3%).

Beneficiaries with MDD were primarily eligible for Medicare due to age (FFS and MA, 76% vs. 55%) while most SCZ and BP I patients qualified due to disability (FFS, 76% and 67%; MA, 73% and 76%). Also, Medicare beneficiaries with SCZ were far more likely to be dual eligible for Medicaid compared to BP I and MDD patients (FFS, 83% vs. 70% and 36%; MA, 71% vs. 62% and 42%). The researchers noted that Medicare patients with SCZ were less likely to be married or own their home and more likely to live alone below the federal poverty level and/or in a high unemployment area, have a high school education or less, not own a vehicle, and speak English not well or not at all. Moreover, FFS beneficiaries were two-fold more likely to live in an area with a shortage of mental health practitioners compared to MA beneficiaries, highlighting a disparity in specialty practitioner access for those living in rural areas.

“This study found a high SDOH burden among Medicare beneficiaries with serious mental illness, especially those with SCZ. It is essential to understand the impact of SDOH on health care utilization and outcomes in the vulnerable Medicare population, which can compound their heavy comorbidity burden. If unaddressed, social risk factors can lead to worse health outcome and higher costs in the Medicare population with serious mental illness,” the researchers concluded.

Source: Teigland C, et al. Medicare Beneficiaries with Serious Mental Illness (SMI) Have High Prevalence of Social Determinants of Health. Poster F20. Published for AMCP Nexus 2021; October 18-21, 2021, Denver, CO.