Depression outcomes worse for Minnesota's poor

Minnesota clinics perform much better treating depression among patients with private insurance than among low-income patients covered by state-subsidized Medicaid plans, according to a new state report that scrutinized racial and socioeconomic gaps in medicine last year.

The success rate in either population isn't great — only 5.5 percent of low-income Medicaid patients beat depression in six months, compared with 9.9 percent of patients with private insurance or other sources of health coverage.

But the disparity indicates additional challenges among low-income Minnesotans that many primary care clinics aren't addressing. Follow-up screenings or check-in calls that can help depressed patients recover, for example, might be more challenging with low-income patients who have unstable housing and can be harder to track down, said James Chase, president of Minnesota Community Measurement, which released the report Thursday.

"People want to take this on because [depression care] is so important — not just for the impact on patients but on families and communities and everybody," Chase said. "The challenge is … what do you need to do differently for disparity populations? What can we do differently with public programs so we can get better results?"

The socioeconomic disparity in depression care was one of several highlighted in the report, which was based on clinic data for 2015.

While 74.3 percent of patients with private or other insurance sources received scheduled colon cancer screenings, only 53.9 percent of Medicaid-covered adults received them, the report found. There was a similar gap of 15 percentage points in women receiving recommended mammograms.

Gaps in depression care are receiving greater attention in Minnesota, partly because the state's clinics are performing so poorly on the measure.

"When people are depressed they don't show up to work and perform well, they don't perform well in their families, they don't perform well in school," said Dr. Paul Goering, vice president of mental health for Allina Health. "But there's also a profound medical argument. If you're not doing well with your depression, you're not taking care of your blood pressure, your diabetes, your obesity, your chronic back pain."

Allina is testing a solution at its Woodbury clinic, which had a significant disparity in depression remission rates — only 3 percent for the Medicaid population vs. 13.7 percent for others, according to the Community Measurement report. The idea is to make mental health providers and services that used to be considered specialties — such as stress reduction and mindfulness training — immediately available at primary care clinics and to offer them to patients.

The Minnesota Department of Human Services, which operates Medicaid programs, lays some blame for the disparity on poverty rather than doctors' performance.

"We know that both direct and compounding factors affect health outcomes, including having dependable access to transportation, housing, healthy food, education, and employment," the agency said in a statement.

However, the agency also directed Minnesota's Medicaid managed care insurers last year to create incentives so doctors and clinics keep their patients on prescribed antidepressants longer and follow up with them if they have been hospitalized.

Allina's East Lake Street Clinic has a disproportionate share of patients whose depression was related to pregnancy and new parenting, he said, and needed an outreach program tailored to that.

"Their needs were distinctly different," he said. "We weren't going to be able to help them differently by different medication choices or by referring them to psychology more."