Medicaid Value Based Payment Models and Healthcare Equity for Adults with Serious Mental Illnesses

项目摘要/摘要 为了在降低成本的同时改善健康结果，医疗补助基于价值的支付 (VBP)模型奖励供应商的质量。来自国家机构的早期证据表明 医疗补助VBP模型在实现其#年的健康和经济目标方面取得了一定成功 普通受益人。然而，尽管医疗补助是昂贵的关键支付者 严重精神疾病(SMI)成人所需的医疗保健，对VBP的影响知之甚少 关于患有SMI的医疗补助受益人，特别是那些属于种族/少数民族群体的人。 我们的研究团队和其他人记录了在访问、质量和 黑人和拉丁裔相对于患有SMI的白人成年人的医疗保健结果。我们和其他人 还表明，对患有精神疾病的人有一般益处的政策 可能不会平等地惠及所有人--例如，我们证明，虽然《平价医疗法案》 虽然改善了获得精神卫生保健的机会，但对#年广泛的种族/族裔差距没有影响。 获得心理健康治疗的机会。应对服务交付变化的挑战 由于基线较差，SMI患者和少数族裔患者的VBP可能更大 医疗服务的可获得性和质量及其更大的社会劣势。缺乏关于这方面的数据 VBP对患有SMI的种族/民族少数群体的公平影响是一个关键的证据差距。 我们建议评估VBP模型对种族/民族心理健康差异的影响 SMI患者的治疗。我们将使用2010-2019年的纵向医疗补助报销申请 俄勒冈州和纽约州，这两个州已经实施了针对这两个州的混合VBP模式 提供者和管理保健组织，并将这些数据与国家提供者数据和 区域层面的特点。对于每个州，我们评估(A)VBP模型的总体影响为 以及(B)调查不同的VBP模型在州内的影响(即差异 对差异的影响归因于管理型医疗组织如何与 提供商)。我们的初步分析估计了VBP实施的不同影响，包括 患有SMI的医疗补助受益人，按种族/民族(白人、黑人或西班牙裔/拉丁裔) 医疗保健：(目标1)获取、(目标2)质量、(目标3)效率和(目标4)成本。 这项拟议的研究将为考虑采用VBP的国家提供有意义的证据。它 符合NIMH战略目标4.1(提高 现有的心理健康服务)，并寻求填补证据空白 国家政策对重度精神分裂症患者的公平医疗保健的影响。

Project Summary/Abstract In order to improve health outcomes while reducing costs, Medicaid Value Based Payment (VBP) models reward providers for quality. Early evidence from state agencies suggests that Medicaid VBP models had moderate success in meeting their health and economic targets for the average beneficiary. However, despite the fact Medicaid is a critical payer for costly healthcare needed by adults with Serious Mental Illness (SMI), little is known about VBP effects on Medicaid beneficiaries with SMI, especially those belonging to racial/ethnic minority groups. Our research team and others have documented significant disparities in access, quality, and outcomes of healthcare for Black and Latino relative to White adults with SMI. We and others have also shown that policies with average beneficial effects for people with mental illnesses may not benefit everyone equally—e.g., we demonstrated that while the Affordable Care Act improved access to mental healthcare, it had no impact on the wide racial/ethnic disparities in access to mental health treatment. The challenges of navigating service delivery changes in VBP may be greater for people with SMI and for minority patients due to poorer baseline healthcare access and quality and their greater social disadvantage. A lack of data on the equity impacts of VBP for racial/ethnic minorities with SMI is a crucial evidentiary gap. We propose to evaluate the impact of VBP models on racial/ethnic disparities in mental health treatment among patients with SMI. We will use longitudinal 2010-2019 Medicaid claims from Oregon and New York, two states that have implemented hybrid VBP models targeting both providers and managed care organizations, and link these data to national provider data and area-level characteristics. For each state, we evaluate (a) the overall impact of VBP models as well as (b) investigate the impact of different VBP models within states (i.e., the differential impact on disparities attributed to variation in how managed care organizations contracted with providers). Our primary analyses estimate the differential impact of VBP implementation, among Medicaid beneficiaries with SMI, by race/ethnicity (White, Black, or Hispanic/Latino) for healthcare: (Aim 1) access, (Aim 2) quality, (Aim 3) effectiveness, and (Aim 4) costs. The proposed research will provide meaningful evidence to states considering VBP adoption. It is consistent with NIMH Strategic Objective 4.1 (Improve the efficiency and effectiveness of existing mental health services through research), and seeks to fill the evidentiary gap in the effects of state policies on equitable health care for individuals living with SMI.