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

项目总结/摘要 医疗补助患者经历显著的健康不公平。医疗补助患者获得初级医疗服务的机会较差 这导致不良健康事件和使用高成本服务。医疗补助行为健康 (BH)患者面临更糟糕的结果。医疗补助BH患者有更高的共病身体疾病的发生率， 并且其花费和死亡率是没有BH诊断的人的四倍。Medicaid BH 患者需要复杂的临床协调，因此迫切需要跨交付环境进行护理整合 政策目标。为了提高BH患者的利用率和健康结果， 该国正在采用按业绩计薪的办法来实施交付系统改革。P4P支付方案 报销医疗服务提供者实现质量流程和结果里程碑而不是服务量的费用。 2014年，纽约（NY）医疗补助计划制定了一项计划， 以便为交付改革举措提供资金。P4 P可能特别有利于BH患者，他们的护理需求复杂 协调和提高质量标准化。越来越多的州要求采用医疗补助P4P， 然而，P4P计划的影响尚未在医疗补助计划中得到严格研究，特别是在 行为健康护理这项研究调查了医疗补助P4P改革是否能有效改善健康状况 单相抑郁症、双相抑郁症和精神分裂症患者的结局和利用。我们将 使用差异中差异（DiD）分析比较Medicaid BH患者的利用率和结局 从接受P4P激励的提供者那里接受护理，以利用Medicaid BH患者的结果 从没有P4P激励的提供者那里获得护理。在纽约的P4P计划中，大约70%的医疗补助主要 护理提供者参与了地理上不同的环境， 未暴露的医疗补助BH支付改革。将对结局进行描述性统计和初步结果 提出了将讨论分析问题，包括解决潜在偏见和群体的方法。 比较性，如倾向评分权重。该提案还包括对我的详细描述。 培训计划，包括科学的职业发展培训，以及关于优秀培训的详细说明 纽约大学格罗斯曼医学院MSTP项目的环境。

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.