How does implementation of Pay-for-Performance and Collaborative Care impact utilization and health outcomes for Medicaid Behavioral Health patients

按绩效付费和协作护理的实施如何影响医疗补助行为健康患者的利用率和健康结果

• 批准号: 10463148
• 负责人: Ashley Lewis
• 金额: $ 4.63万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-28 至 2024-09-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10463148
• 关键词: Address; Adopted; American; Bipolar Depression; Caring; Clinical; Complex; Country; Data; Diagnosis; Disease; Effectiveness; Environment; Event; Face; Future; Geography; Goals; Health; Health Insurance; Health Personnel; Health Services; Healthcare; Incentives; Insurance Carriers; Insurance Coverage; Joints; Low income; Measures; Medicaid; Mental Depression; Modeling; National Institute of Mental Health; New York; Outcome; Patients; Pattern; Performance; Policies; Population; Primary Health Care; Process; Provider; Quality of Care; Research Support; Risk; Schizophrenia; Services; Standardization; Strategic Planning; System; Testing; Time; Training; Translating; Unipolar Depression; Weight; barrier to care; behavioral health; behavioral outcome; care delivery; care providers; career development; collaborative care; comorbidity; cost; design; effectiveness evaluation; effectiveness validation; evidence base; experience; health inequalities; improved; improved outcome; interest; medical schools; mortality; payment; population health; programs; response; statistics

Project Summary/Abstract Medicaid patients experience significant health inequities. Medicaid patients have worse access to primary care, which leads to adverse health events and utilization of high-cost services. Medicaid behavioral health (BH) patients face even worse outcomes. Medicaid BH patients have higher rates of comorbid physical illness, and have four times higher spending and mortality rates than those without a BH diagnosis. Medicaid BH patients require complex clinical coordination, making care integration across delivery settings an urgent policy goal. In an effort to improve utilization and health outcomes for BH patients, Medicaid programs across the country are using pay-for-performance (P4P) to enact delivery system reform. P4P payment programs reimburse health providers for achieving quality process and outcome milestones instead of services volume. In 2014, New York (NY) Medicaid established a program by which health providers were paid using P4P in order to finance delivery reform initiatives. P4P may especially benefit BH patients, whose complex care needs coordination and increased quality standardization. There is a growing push for states to adopt Medicaid P4P, yet the impact of P4P programs have not been rigorously studied within Medicaid, especially in the context of behavioral health care. This study investigates if Medicaid P4P reform is effective at improving health outcomes and utilization for patients with unipolar depression, bipolar depression, and schizophrenia. We will use a difference-in-differences (DiD) analysis to compare utilization and outcomes of Medicaid BH patients receiving care from providers receiving P4P incentives to utilization and outcomes of Medicaid BH patients receiving care from providers without P4P incentives. In NY’s P4P program, about 70% of all Medicaid primary care providers participated in geographically diverse settings, enabling construction of exposed and unexposed Medicaid BH to payment reform. Descriptive statistics and preliminary results on outcomes will be presented. Analytic issues will be discussed, including approaches to address potential bias and group comparability such as propensity score weights. This proposal also includes a detailed description of my training plan, including scientific and career development training, as well as details on the excellent training environment of NYU Grossman School of Medicine’s MSTP program.

项目摘要/摘要 医疗补助计划的患者经历了严重的健康不平等。医疗补助患者获得初级保健服务的机会较差 护理，这会导致不良的健康事件和利用高成本服务。医疗补助行为健康 (Bh)患者面临更糟糕的结果。医疗补助计划BH患者的并存身体疾病的比率更高， 与那些没有BH诊断的人相比，他们的支出和死亡率高出四倍。医疗补助BH 患者需要复杂的临床协调，这使得跨交付环境的护理集成成为当务之急 政策目标。为了努力改善BH患者的利用率和健康结果，整个医疗补助计划 中国正在使用绩效工资(P4P)来实施交付系统改革。P4P支付计划 补偿医疗服务提供者实现高质量的过程和结果里程碑，而不是服务量。 2014年，纽约(NY)医疗补助计划建立了一项计划，通过该计划，医疗服务提供者使用P4P支付 以便为交付改革举措提供资金。P4P可能尤其有利于BH患者，他们的护理需求复杂 协调和提高质量标准化。越来越多的州正在推动采用医疗补助P4P， 然而，P4P计划的影响在医疗补助中没有得到严格的研究，特别是在 行为健康护理。这项研究调查了医疗补助P4P改革是否在改善健康方面有效 单相抑郁、双相抑郁和精神分裂症患者的结局和利用。我们会 使用差异性(DID)分析比较医疗补助BH患者的利用情况和结果 接受接受P4P激励的提供者对医疗补助BH患者的利用和结果的关怀 接受没有P4P激励的提供者的护理。在纽约的P4P计划中，约70%的医疗补助初选 护理提供者参与了不同地理位置的设置，从而能够构建暴露和 未暴露于医疗补助BH的支付改革。关于结果的描述性统计和初步结果将是 呈上了。将讨论分析问题，包括解决潜在偏见和群体的方法 可比性，如倾向性分值权重。这份建议书还包括对我的 培训计划，包括科学培训和职业发展培训，以及关于优秀培训的细节 纽约大学格罗斯曼医学院MSTP项目的环境。