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

项目概要/摘要 为了在降低成本的同时改善健康结果，Medicaid基于价值的支付 (VBP)模型奖励提供者的质量。来自州政府机构的早期证据表明， 医疗补助VBP模型在满足其健康和经济目标方面取得了适度的成功， 平均受益人。然而，尽管事实上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 医疗补助受益人与SMI，特别是那些属于种族/少数民族群体。 我们的研究团队和其他人已经记录了在获取，质量和 与白色成年SMI患者相比，黑人和拉丁美洲人的医疗保健结局。我们和其他人 还表明，对精神疾病患者有平均有益效果的政策， 可能不会平等地使每个人受益-例如，我们证明了尽管《平价医疗法案》 改善获得精神保健的机会，但对广泛的种族/民族差异没有影响， 获得心理健康治疗。在以下领域应对服务提供变化的挑战 由于基线较差，SMI患者和少数患者的VBP可能更高 医疗保健的获取和质量以及他们更大的社会劣势。缺乏关于 越南船民对有严重精神创伤的少数种族/族裔的公平影响是一个关键的证据差距。 我们建议评估VBP模型对心理健康种族/民族差异的影响 SMI患者的治疗。我们将使用纵向2010-2019年医疗补助索赔， 俄勒冈州和纽约，这两个州已经实施了混合型的越南船民模式， 提供者和管理式护理组织，并将这些数据与国家提供者数据联系起来， 区域级特征。对于每个州，我们评估（a）越南船民模式的整体影响， 以及（B）调查州内不同VBP模型的影响（即，差动 管理式护理组织如何与 供应商）。我们的初步分析估计了实施越南船民政策的不同影响， 按种族/民族（白色、黑人或西班牙裔/拉丁裔）列出的患有SMI的医疗补助受益人， 医疗保健：（目标1）可及性，（目标2）质量，（目标3）有效性和（目标4）成本。 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 通过研究现有的精神卫生服务），并寻求填补证据空白， 国家政策对重度精神障碍患者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.