Marisa Elena Domino, PhD, is a professor in the Department of Health Policy and Management in the Gillings School of Global Public Health; she is also director of the Program on Mental Health and Substance Abuse Systems and Services Research at the Cecil G. Sheps Center for Health Services Research. Her research interests include the economics of mental health, agency relationships among physicians, patients and insurers, the diffusion of new technologies and the public provision of health care and health insurance to low-income populations. She is deeply interested in vulnerable populations and she has created a research agenda throughout her career which examines the efficiency of health care policies in low income and disabled populations. She has substantial expertise in applied econometric analyses and has worked extensively on large administrative databases from a variety of health insurance programs. She has considerable experience extracting measures of medication use and adherence, quality of care, utilization and costs from a large variety of data sources. Dr. Domino’s work has focused on the effects of Medicaid program design on a variety of populations and outcomes, especially related to behavioral health and chronic illness.
Areas of Expertise (11)
Edward G. McGavran Award for Excellence in Teaching
UNC Gillings School of Global Public Health, 2017
Award for Excellence in Application of Pharmoeconomics and Health Outcomes Research
ISPOR , 2013
The University of Arizona: BSPA, Health Administration
Johns Hopkins University: PhD, Health Economics
Harvard Medical School: Postdoctoral Fellowship, Mental Health Economics
HPM 718: Readings in Mental Health Services Research and Policy
This course is an introduction to mental health services research and policy. Topics include the financing of mental health services, supply of services, quality measures, assessing need, and barriers to care. The course includes seminar presentations by local and nationally recognized experts in mental health services research and discussion sessions.
HPM 883: Analysis of Categorical Data
Prerequisites: HPM 881 and 882 or equivalent. This course is an introduction to the analysis of categorical data using maximum likelihood and other non-linear techniques and specification tests. Topics include models in which the dependent variable is not continuous, including logit, probit, censored data, two-part, and count models.
Domino ME, Lin CC, Morrissey JP, Ellis AR, Fraher E, Richman EL, Thomas KC, Prinstein MJ
To examine trends in the psychologist workforce and training opportunities, including factors that may influence the decision of clinical psychologists to practice in rural settings.
We use a mixed-methods approach to examine the psychologist workforce nationally and in North Carolina (NC), including (1) an analysis of the location of programs awarding doctoral degrees; (2) an analysis of the practice, demographic, and educational characteristics of the psychologist workforce; and (3) interviews with directors of doctoral programs in clinical psychology to understand where current graduates are getting jobs and why they may or may not be choosing to practice in rural communities.
Fewer than 1% of programs and institutions awarding doctoral degrees in psychology in the United States are located in rural areas. In NC, approximately 80% of practicing psychologists have out-of-state degrees and about 80% of recent NC graduates are not currently licensed in the state. This juxtaposition undermines the utility of adding more in-state degree programs. While expansion of training programs within rural areas could help alleviate the shortages of mental health providers, adding new degree-granting programs alone will not necessarily increase supply. We discuss complementary recruitment and retention strategies, including greater incentives for rural training and practice as well as training in emerging technologies that don't require providers to be physically located in underserved areas, such as telemedicine.
Increasing the supply of psychologists practicing in rural areas will require a thoughtful, multipronged approach to training this critical part of the behavioral health workforce.
Hillemeier MM, Domino ME, Wells R, Goyal RK, Kum HC, Cilenti D, Basu A
To examine effects of maternity care coordination (MCC) on perinatal health care utilization among low-income women.
North Carolina Center for Health Statistics Baby Love files that include birth certificates, maternity care coordination records, WIC records, and Medicaid claims.
Causal effects of MCC participation on health care outcomes were estimated in a sample of 7,124 singleton Medicaid-covered births using multiple linear regressions with inverse probability of treatment weighting (IPTW).
Maternity care coordination recipients were more likely to receive first-trimester prenatal care (p < .01) and averaged three more prenatal visits and two additional primary care visits during pregnancy; they were also more likely to participate in WIC and to receive postpartum family planning services (p < .01). Medicaid expenditures were greater among mothers receiving MCC.
Maternity care coordination facilitates access to health care and supportive services among Medicaid-covered women. Increased maternal service utilization may increase expenditures in the short run; however, improved newborn health may reduce the need for costly neonatal care, and by implication the need for early intervention and other supports for at-risk children.
Domino ME, Kilany M, Wells R, Morrissey JP
To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques.
DATA SOURCES/STUDY SETTING:
Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility.
We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses.
Data were received from the Carolina Cost and Quality Initiative.
The four estimation techniques consistently revealed generally positive associations between medical homes and access to primary care, specialty mental health care, greater medication adherence, slightly lower emergency room use, and greater expenditures. These findings were consistent across all three major severe mental illness diagnostic groups. Some heterogeneity in effects were noted, especially in preventive screening.
Expanding access to primary care-based medical homes for people with severe mental illness may not save money for insurance providers, due to greater access for important outpatient services with little cost offset. Health services research examining more of the treatment heterogeneity may contribute to more realistic projections about medical homes outcomes.
Marisa E. Domino, PhD, Carlos Jackson, PhD, Christopher A. Beadles, MD, PhD, Jesse Lichstein, MSPH, Alan R. Ellis, PhD, MSW, Joel F. Farley, PhD, Joseph P. Morrissey, PhD, Annette DuBard, MD, MPH
Primary-care-based medical homes may facilitate care transitions for persons with multiple chronic conditions (MCC) including serious mental illness. The purpose of this manuscript is to assess outpatient follow-up rates with primary care and mental health providers following psychiatric discharge by medical home enrollment and medical complexity.