# The Role of Insurance Networks and Organizational Factors in Guideline-Concordant Care for Serious Mental Illness

> **NIH NIH R34** · UNIVERSITY OF MASSACHUSETTS AMHERST · 2022 · $239,250

## Abstract

PROJECT SUMMARY
 Serious mental illness affects more than 5% of the United States population, but only a small proportion
of these individuals receive adequate treatment. Schizophrenia impacts one percent of the population and is
particularly debilitating. Individuals with schizophrenia have high rates of poor health and social outcomes,
including premature mortality, homelessness, and substance use. Individuals with schizophrenia are at
increased risk of suicide and have high rates of comorbid disease. Guideline-concordant care (GCC) –
including appropriate medications and psychotherapy – improves outcomes for individuals with schizophrenia,
including mortality. However, rates of GCC are low, with significant variation across patient demographic
groups, clinical conditions, and clinician types. Although some differences may be explained by patient
preferences, system factors at the insurance and organization levels likely contribute to low rates of GCC.
Better understanding system factors – including the role of insurance networks and organizations – that help
guide treatment pathways towards GCC and improve patient outcomes is an important contribution to
improving clinical practice for individuals living with schizophrenia. Pursuant to the goals of PAR-19-189, the
objective of this pilot services research is to identify mutable health care system factors related to access and
quality of mental health services. Using comprehensive health insurance enrollment and claims data from
Massachusetts we quantify and examine variation in insurance networks for those with schizophrenia, examine
associations of these network characteristics – including size and composition (reflecting availability of mental
health clinicians) – with patient outcomes of guideline-concordant care receipt and self-harm. As a potential
mechanism for understanding how insurance networks may influence patient outcomes, we examine
associations of organizational characteristics – organization size and proportion of mental health clinicians –
with patient outcomes. We conduct sensitivity analyses limiting to individuals with first episode psychosis due
to the clinical urgency of comprehensive care and policy interest in this population, and establish a causal
relationship between insurance networks and organizations and outcomes using a young adult sample.
Understanding factors associated with GCC and outcomes will help identify effective policy levers to improve
care. Findings from this pilot study will guide future improvements in mental health services delivery, as well as
identify avenues for future research on policy changes influencing critical system characteristics.

## Key facts

- **NIH application ID:** 10468945
- **Project number:** 5R34MH123628-02
- **Recipient organization:** UNIVERSITY OF MASSACHUSETTS AMHERST
- **Principal Investigator:** Kimberley Lynn H Geissler
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $239,250
- **Award type:** 5
- **Project period:** 2021-08-13 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10468945

## Citation

> US National Institutes of Health, RePORTER application 10468945, The Role of Insurance Networks and Organizational Factors in Guideline-Concordant Care for Serious Mental Illness (5R34MH123628-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10468945. Licensed CC0.

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