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

基于医疗补助价值的支付模式和患有严重精神疾病的成年人的医疗保健公平

• 批准号: 9916991
• 负责人: Benjamin Le Cook
• 金额: $ 79.3万
• 依托单位: CAMBRIDGE HEALTH ALLIANCE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-14 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9916991
• 关键词: Achievement; Adopted; Adoption; Adult; Affordable Care Act; Area; Budgets; Caring; Characteristics; Complex; Contracts; Cost Savings; Data; Effectiveness; Ethnic Origin; Fee-for-Service Plans; Goals; Growth; Health; Health Benefit; Health Care Costs; Health Care Quality Indicators; Health Policy; Health Services Accessibility; Healthcare; Hispanics; Hospitalization; Hybrids; Improve Access; Incentives; Individual; Latino; Link; Managed Care; Measures; Medicaid; Mental Health; Mental Health Services; Mental disorders; Minority; Minority Groups; Modeling; National Institute of Mental Health; New York; Oregon; Outcome; Outpatients; Patients; Performance; Pharmaceutical Preparations; Policies; Population; Provider; Psyche structure; Race; Research; Review Literature; Rewards; Services; Time; Underserved Population; Variant; Visit; Work; base; behavioral health; beneficiary; care outcomes; community based service; cost; design; ethnic diversity; ethnic minority population; follow-up; health care availability; health care disparity; health care quality; health disparity; health economics; hospital readmission; improved; innovation; meetings; mortality; payment; physical conditioning; pressure; programs; racial and ethnic; racial and ethnic disparities; service delivery; severe mental illness; social disadvantage; social health determinants; success; wasting

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.

项目概要/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) 模型奖励提供者的质量。来自国家机构的早期证据表明 医疗补助 VBP 模型在实现其健康和经济目标方面取得了一定的成功 平均受益人。然而，尽管事实上医疗补助是昂贵费用的关键支付者 患有严重精神疾病 (SMI) 的成年人需要医疗保健，但人们对 VBP 的影响知之甚少 具有 SMI 的医疗补助受益人，特别是属于少数种族/族裔群体的受益人。 我们的研究团队和其他人记录了在访问、质量和服务方面的巨大差异。 与患有 SMI 的白人成年人相比，黑人和拉丁裔的医疗保健结果。我们和其他人 还表明，对精神疾病患者具有平均有益效果的政策 可能无法平等地使每个人受益——例如，我们证明，虽然《平价医疗法案》 改善了获得精神保健的机会，但这对广泛的种族/民族差异没有影响 获得心理健康治疗。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 可能更高 医疗保健的获取和质量及其更大的社会劣势。缺乏相关数据 VBP 对具有 SMI 的少数种族/族裔的公平影响是一个重要的证据差距。 我们建议评估 VBP 模型对心理健康方面种族/民族差异的影响 SMI 患者的治疗。我们将使用 2010-2019 年医疗补助索赔的纵向数据 俄勒冈州和纽约州这两个州已经针对这两个州实施了混合 VBP 模型 提供者和管理式医疗组织，并将这些数据链接到国家提供者数据和 区域层面的特征。对于每个州，我们评估 (a) VBP 模型的总体影响为 (b) 研究各州内不同 VBP 模型的影响（即微分 管理式医疗组织与医疗机构签订合同方式的差异对差异的影响 提供商）。我们的初步分析估计了 ​​VBP 实施的不同影响，其中 具有 SMI 的医疗补助受益人，按种族/族裔（白人、黑人或西班牙裔/拉丁裔）分类 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 SMI 患者公平医疗保健的影响。