Mental Health Care Under New Payment Strategies

项目摘要 考虑到一系列有效的循证治疗方法，为严重精神疾病（SMI）患者提供的护理质量远远落后于治疗这些患者的潜力。护理的分散和僵化，不一致的支付方法导致SMI患者的身心健康护理不足。新的合同和支付策略旨在通过经济激励和明确的护理质量基准来提高SMI患者的护理质量和价值。这些新兴策略有望提高SMI患者的护理效率和有效性，这是2015年NIMH研究战略计划的目标之一。尽管公共保险公司越来越多地采用新的支付策略，为SMI患者提供不成比例的保险，但很少有证据说明这些变化是否以及如何与这一弱势群体的护理质量和结局相关，甚至更少有人知道合同或组织功能可能会提高SMI患者的护理质量。新的卫生保健支付和提供合同有许多目标：鼓励协调保健，促进在最适当的环境中提供保健，改善人口健康，控制卫生保健费用。在这项拟议的研究中，使用新型支付合同的开始日期，我们将1）研究供应商和保险公司之间的新兴合同如何解决SMI患者的医疗保健问题; 2）估计SMI患者的护理质量和结局如何随着支付合同设计和组织策略而变化;以及3）估计人口健康措施如何与针对精神疾病患者的身心健康护理的合同设计和组织战略相关联。为了完成这项研究，我们将开发和领域的心理健康的重点波正在进行的调查医疗保健提供者组织（目标1）。我们将把这些关于合同设计和心理健康特定组织策略的新调查数据与患者层面的行政索赔数据（目标2和3）联系起来，以更好地了解新兴合同对SMI患者的护理质量和人群健康结果的影响。拟议的研究将有助于调整新兴的支付合同和组织战略，以满足精神疾病患者的需求。

PROJECT SUMMARY The quality of care delivered to patients with serious mental illness (SMI) lags well behind the potential to treat these patients, given an array of efficacious evidence-based treatments available. Fragmentation of care and rigid, poorly aligned payment approaches contribute to inadequate physical and mental health care for patients with SMI. New contracting and payment strategies aim to increase the quality and value of care for patients with SMI using financial incentives and explicit quality of care benchmarks. These emerging strategies hold promise for increasing the efficiency and effectiveness of care for patients with SMI, one of the objectives in the 2015 NIMH Strategic Plan for Research. Despite increasing adoption of new payment strategies by public insurers, which insure a disproportionate share of patients with SMI, scant evidence describes whether and how these changes are linked to quality of care and outcomes for this vulnerable group, and even less is known about contract or organization features that may improve quality of care for patients with SMI. New health care payment and delivery contracts have many goals: encouraging coordination of care, promoting delivery of care in the most appropriate setting, improving population health, and containing health care costs. In this proposed research, using the start date of novel payment contracts, we will 1) examine how emerging contracts between providers and insurers address health care for patients with SMI; 2) estimate how the quality of care and outcomes for patients with SMI change with payment contract designs and organizational strategies; and 3) estimate how population health measures are associated with contract designs and organizational strategies targeting physical and mental health care for people with mental illness. To complete the research, we will develop and field a mental health­focused wave of an ongoing survey of health care provider organizations (Aim 1). We will link these new survey data on contract designs and mental health-specific organizational strategies to patient-level administrative claims data (Aims 2 and 3) to better understand the implications of emerging contracts for quality of care and population health outcomes for people with SMI. The proposed research will help to tailor emerging payment contracts and organizational strategies to meet the needs of populations with mental illness.