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Mental Health Provider Networks in Medicaid and Implications for Care Utilization and Health Outcomes

医疗补助中的心理健康提供者网络及其对护理利用和健康结果的影响

基本信息

批准号：
10666416
负责人：
Jane Mingjia Zhu
金额：
$ 18.9万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
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：
2020-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10666416
关键词：
Address Affordable Care Act Career Mobility Caring Characteristics Clinical Clinical Management Complex Continuity of Patient Care Contracts Data Data Analyses Data Linkages Data Set Dedications Development Development Plans Diagnosis Effectiveness Electronic Health Record Emergency department visit Ensure Environment Equilibrium Future Health Health Care Rationing Health Personnel Health Services Health Services Accessibility Health care facility Health system Healthcare Hospitalization Improve Access Institution Insurance Claim Review Internist Interview Knowledge Learning Link Literature Location Managed Care Programs Measures Medicaid Medical Mental Health Mental Health Services Mental disorders Mentors Mentorship Methodology Methods Monitor Oregon Outcome Overdose Patient-Focused Outcomes Patients Pattern Pharmaceutical Preparations Physicians Policy Maker Population Primary Care Provider Psychiatrist Psychiatry Psychotherapy Quality of Care Regulation Research Research Methodology Research Personnel Resources Sampling Science Scientist Self-Injurious Behavior Statutes and Laws Structure Subgroup Time Training Travel United States Centers for Medicare and Medicaid Services Universities Variant Vulnerable Populations Work barrier to care beneficiary care delivery care outcomes career career development density design electronic health data health care availability health care delivery health care service health care service utilization health plan hospital readmission improved interest learning strategy medical specialties member mental health organization multidisciplinary parity programs provider networks public health insurance service delivery severe mental illness skills social success suicide rate tool

项目摘要

Project Summary/Abstract Candidate: Jane M. Zhu, MD, MPP, MSHP is a primary care internist and health services researcher who is passionate about improving access to health care and health outcomes for vulnerable populations. She has a particular interest in mental health care. To advance her career towards independence, she seeks didactic and experiential training to develop subject matter expertise in mental health; methodologic expertise in Medicaid claims analysis and training for future electronic health data linkages; and qualitative and mixed methods skills. Research Context: A provider network is a list of all health care providers and facilities that a health plan has contracted with to provide medical care to its members. There is little understanding of what characteristics of mental health provider networks are important for providing high-quality care despite ongoing monitoring and regulation efforts. This need is magnified in Medicaid, one of the largest payers for mental health care in the U.S. This proposal seeks to understand which key modifiable characteristics of provider networks can improve care utilization and clinical outcomes for Medicaid beneficiaries with mental health diagnoses, to help enable health care institutions and policymakers to more effectively balance the tensions between increased access to treatment and the resource constraints faced by a public insurance program. Specific Aims: 1) Characterize variation in mental health provider networks; 2a) Measure the association between provider network characteristics and care utilization patterns and clinical outcomes; 2b) Assess differential associations between provider networks and care utilization patterns and clinical outcomes in a sub- group of beneficiaries with severe mental illness (SMI); 3) Identify how care delivery factors interface with provider networks to explain variations in mental health care utilization patterns and clinical outcomes. Research Plan: To accomplish these aims, Dr. Zhu will learn and apply a sequential explanatory mixed- methods approach that leverages network variation from 2014-2018 in Oregon’s Medicaid program, combining Medicaid administrative claims analysis with document analysis and qualitative interviews of in-network providers. A future R01 will utilize a multi-state sample to examine the impact of variation in provider networks on quality of mental health care, via Medicaid Analytic eXtract data linked to electronic health records. Career Development Plan: Working closely with her mentors, Dr. Zhu will 1) develop subject matter expertise in the design and organization of mental health coverage and service delivery; 2) gain methodologic expertise in analyzing Medicaid administrative datasets alongside foundational training in supplementing claims-based analyses with electronic health record data; and 3) develop skills in qualitative and mixed methods research. Environment: Oregon Health and Science University offers an ideal environment to pursue this training, with well-established mentors dedicated to Dr. Zhu’s success and a number of multi-disciplinary institutions and collaborators with a track record of producing successful, independent health services investigators.

项目总结/文摘

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Phantom Networks: Discrepancies Between Reported And Realized Mental Health Care Access In Oregon Medicaid.

DOI：
10.1377/hlthaff.2022.00052
发表时间：
2022-07
期刊：
HEALTH AFFAIRS
影响因子：
9.7
作者：
Zhu, Jane M.;Charlesworth, Christina J.;Polsky, Daniel;McConnell, K. John
通讯作者：
McConnell, K. John

Medicaid Managed Care Network Adequacy Standards for Mental Health Care Access: Balancing Flexibility and Accountability.

医疗补助管理医疗网络精神卫生保健获取的充分性标准：平衡灵活性和问责制。

DOI：
10.1001/jamahealthforum.2021.0280
发表时间：
2021
期刊：
JAMA health forum
影响因子：
0
作者：
Zhu,JaneM;Breslau,Joshua;McConnell,KJohn
通讯作者：
McConnell,KJohn

Variation in network adequacy standards in Medicaid managed care.

DOI：
10.37765/ajmc.2022.89156
发表时间：
2022-06
期刊：
AMERICAN JOURNAL OF MANAGED CARE
影响因子：
3.2
作者：
Zhu, Jane M.;Polsky, Daniel;Johnstone, Cameron;McConnell, K. John
通讯作者：
McConnell, K. John

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid.

农村和边境获得心理健康处方者和非处方者的机会：俄勒冈州医疗补助的地理空间分析。

DOI：
10.1111/jrh.12761
发表时间：
2024
期刊：
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
影响因子：
0
作者：
Charlesworth,ChristinaJ;Nagy,Dylan;Drake,Coleman;Manibusan,Brynna;Zhu,JaneM
通讯作者：
Zhu,JaneM

Medicaid Reimbursement For Psychiatric Services: Comparisons Across States And With Medicare.

DOI：
10.1377/hlthaff.2022.00805
发表时间：
2023-04
期刊：
HEALTH AFFAIRS
影响因子：
9.7
作者：
Zhu, Jane M.;Renfro, Stephanie;Watson, Kelsey;Deshmukh, Ashmira;McConnell, K. John
通讯作者：
McConnell, K. John