权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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

基本信息

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
项目类别：
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

项目摘要

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.

项目总结/文摘