PCORI: Mental Health Research and Outcomes

Studying mental health disorders for care optimization

By Lisa A. Marino, FLMI 1, ACS, HIAA
Group Health Senior Underwriter
Insurance Officer
LMarino@McGriffInsurance.com

National tragedies have heightened mental and behavioral health awareness. It is has become increasingly evident that individuals with serious mental health illnesses often struggle to receive proper mental healthcare in order to produce optimal care outcomes. One such struggle is the limitations placed on mental health benefits stipulated in most healthcare policies. The most publicized mental healthcare reform to address this issue is the Mental Health Parity and Addiction and Equity Act (MHPAEA) originally passed in 2008 and amended in 2010 by the Affordable Care Act. Another portion of the Affordable Care Act, the Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization in Washington, DC, was authorized by Congress in 2010 to close that gap. 

The Patient-Centered Outcomes Research Trust Fund fee is a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans that helps to fund the Patient-Centered Outcomes Research Institute (PCORI). The fee applies to policy or plan years ending on or after Oct. 1, 2012, and before Oct. 1, 2019. The amount of the PCORI fee is equal to the average number of lives covered during the policy year or plan year multiplied by the applicable dollar amount for the year. The applicable dollar amount is adjusted yearly to reflect inflation in National Health Expenditures, as determined by the Secretary of Health and Human Services. For policy and plan year ending on or after Oct. 1, 2018, and before Oct. 1, 2019, the applicable dollar amount is $2.45 per employee per year.

As of August 2018 PCORI had awarded $434 million to fund over 100 comparative clinical effectiveness research studies related to mental and behavioral health. PCORI will assist, through research, patients, clinicians, purchasers and policy-makers, in making informed health decisions by advancing the quality and relevance of evidence-based medicine. PCORI’s Evidence Synthesis Initiative takes that approach. The program includes rigorous reviews of the best evidence available on topics of critical concern to patients and other healthcare stakeholders. The goal is to synthesize all relevant completed studies on a particular clinical question in order to provide evidence that is stronger and more certain than the results of the individual studies.

We will focus on one such PCORI study entitled “Using Wellness Coaches and Extra Support to Improve the Health and Wellness of Adults with Serious Mental Illness”, which examines the evidence that people with serious mental illnesses like bipolar disorder or schizophrenia often do not receive optimal mental healthcare nor are they inclined to pursue physical healthcare. It has been established that individuals with serious mental illnesses struggle to receive care to address common chronic physical health problems since they often lack the capacity to communicate effectively, the ability to advocate for themselves, and the comfortability in a doctor patient setting when they are on their own.

In this study, the research team assigned 11 mental health centers by chance utilizing random assignment. The research team gave different forms of health and wellness support to patients with serious mental illness. All patients in the study worked with wellness coaches and all coaches received special training. They taught patients skills to help them manage their health and healthcare. Nurses helped patients get healthcare and improve their health and wellness. The nurses also advised the wellness coaches about working with the patients. Self-directed patients got online or paper resources with information designed for them. Resources included worksheets and manuals to help them improve behaviors like eating healthy food and exercising. The team then compared nurse supported and self-directed outcomes.

The results of this study indicated that the two types of extra support had about the same success in helping patients with serious mental illness. By the end of the study, patients in both groups reported increased involvement in their health care, doctor visits, quality of life and satisfaction with their care. They were also more likely to get routine and specialized physical health care when they needed it. Patients in both groups reported that their mental health improved. At the same time however, they viewed their physical health as being worse. Researchers interpreted the worsening health status as a consequence of patients’ improved understanding and acknowledgement of their health brought about by their increased engagement in preventive and maintenance care. The researchers felt that longer periods of observation would demonstrate a gradual improvement in physical health as patient engagement translated into better health behavior.

Ultimately care collaboration, resource integration and extra support is of paramount importance in optimizing mental, behavioral and physical healthcare outcomes. Similarly PCORI studies employing alternative extra support methods have yielded similar findings. Of utmost importance is disseminating and promoting the uptake of these research findings. The dissemination and promotion process is part of PCORI’s legal mandate to improve the quality and relevance of evidence available to help patients, caregivers, clinicians, employers, insurers, and policymakers make better-informed health decisions. Healthcare and community programs can and should use these results to help people with depression and serious mental health disorders for care optimization. This study is a tangible example of the value of PCORI and its positive impact on the lives of those affected by mental health issues.

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