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

项目摘要/摘要 候选人：简·M·朱，医学博士，MPP，MSHP，初级保健内科医生和卫生服务研究员， 热衷于改善弱势群体获得医疗保健的机会和健康结果。她有一个 对精神卫生保健特别感兴趣。为了推动她的事业走向独立，她寻求说教和 发展心理健康主题专门知识的经验性培训；医疗补助方面的方法学专门知识 针对未来电子健康数据链接的索赔分析和培训；以及定性和混合方法技能。 研究背景：提供者网络是健康计划拥有的所有医疗保健提供者和设施的列表 与其签约，为其成员提供医疗服务。人们很少了解是什么特征 精神卫生提供者网络对于提供高质量的护理很重要，尽管正在进行监测和 监管努力。这种需求在医疗补助计划中被放大了，它是世界上最大的精神卫生保健支付者之一 美国这项提案旨在了解提供商网络的哪些关键可修改特征可以改进 对患有精神健康诊断的医疗补助受益人的护理利用和临床结果，以帮助实现 卫生保健机构和政策制定者更有效地平衡获得更多卫生服务之间的紧张关系 治疗和公共保险计划面临的资源限制。 具体目标：1)描述精神卫生服务提供者网络的差异；2a)衡量两者之间的联系 提供者网络特征与护理利用模式和临床结果之间的关系；2b)评估 提供者网络与护理利用模式和临床结果之间的不同关联 严重精神疾病(SMI)受益人群体；3)确定护理提供因素如何与 提供者网络，以解释精神卫生保健利用模式和临床结果的差异。 研究计划：为了实现这些目标，朱博士将学习并应用顺序解释混合- 在俄勒冈州的医疗补助计划中利用2014-2018年的网络变化的方法方法，结合 医疗补助行政索赔分析--文献分析和网上定性访谈 供应商。未来的R01将利用多状态样本来检查提供商网络变化的影响 关于精神卫生保健的质量，通过Medicaid Analytic摘录链接到电子健康记录的数据。 职业发展计划：朱博士将与导师密切合作，发展专业知识 在设计和组织精神健康覆盖范围和提供服务方面；2)获得方法专业知识 在分析医疗补助管理数据集以及补充基于索赔的基础培训时 使用电子健康记录数据进行分析；以及3)培养定性和混合方法研究的技能。 环境：俄勒冈健康与科学大学为从事这项培训提供了理想的环境， 致力于朱博士成功的知名导师和多个跨学科机构和 具有培养成功的、独立的卫生服务调查人员的记录的合作者。

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.