Provision of Behavioral Health Services at Community Health Centers and Hospital Emergency Department Visits

Abstract

Background: Numerous US patients seek the hospital emergency department (ED) for behavioral health care. Community Health Centers (CHCs) offer a potential channel for redirecting many to a more patient-centered, lower cost setting. Objective: The aim of this study was to identify unique market areas serviced by CHCs and to examine whether CHCs are effective in offsetting behavioral health ED visits. Research Design: We identified CHC-year specific service areas using patient origin zip codes. We then estimated random effects models applied to 42 federally qualified CHCs operating in New York State during 2013–2020. The dependent variables were numbers of ED mental health (substance use disorder) visits per capita in a CHC’s service area, drawn from HCUP State Emergency Department Databases. Key explanatory variables measured CHC number of mental health (substance use disorder) visits, number of unique mental health (substance use disorder) patients, and mental health (substance use disorder) intensity, obtained from the HRSA Uniform Data System. Results: Controlling for population, we observed small negative effects of CHC behavioral health integration in explaining ED behavioral health utilization. Measures of mental health utilization in CHCs were associated with 1.3%–9.3% fewer mental health emergency department visits per capita in Community Health Centers’ service areas. Measures of substance use disorder utilization in Community Health Centers were associated with 1.3%–3.0% fewer emergency department visits per capita. Conclusion: Results suggest that behavioral health integration in CHCs may reduce reliance on hospital EDs, but that policymakers explore more avenues for regional coordination strategies that align services between CHCs and local hospitals.