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.

项目摘要/摘要为了改善健康结果，同时降低成本，基于医疗补助价值付款（VBP）模型奖励提供商的质量。州机构的早期证据表明医疗补助VBP模型在满足其健康和经济目标方面取得了适当的成功平均受益人。但是，尽管医疗补助是昂贵的重要付款人患有严重精神疾病（SMI）的成年人所需的医疗保健，对VBP效果知之甚少在具有SMI的医疗补助受益人中，尤其是属于种族/族裔少数民族群体的受益人。我们的研究团队和其他人都记录了访问，质量和黑人和拉丁裔的医疗保健结果相对于具有SMI的白人成年人。我们和其他人还表明，对精神疾病患者具有平均有益影响的政策可能不会平等地使每个人受益 - 改善了获得心理医疗保健的机会，对广泛的种族/种族分布没有影响获得心理健康治疗。导航服务交付的挑战变化由于基线较差，SMI和少数族裔患者的VBP可能更大医疗保健访问和质量及其更大的社会灾难。缺乏关于 VBP对SMI对种族/族裔少数民族的公平影响是至关重要的证据差距。我们建议评估VBP模型对种族/种族分布对心理健康的影响 SMI患者的治疗。我们将使用2010 - 2019年的纵向医疗补助要求俄勒冈州和纽约，两个州都实施了针对的混合VBP模型提供者和托管护理组织，并将这些数据链接到国家提供者数据以及区域级特征。对于每个州，我们将（a）VBP模型的总体影响评估为以及（b）研究不同VBP模型在状态下的影响（即差异归因于托管护理组织如何签约的差异的影响提供者）。我们的主要分析估计了VBP实施的差异影响与种族/民族（白人，黑人或西班牙裔/拉丁裔）的医疗补助受益人一起医疗保健：（目标1）访问，（目标2）质量，（目标3）有效性和（AIM 4）成本。拟议的研究将为考虑采用VBP采用的各州提供有意义的证据。它与NIMH战略目标4.1一致（提高了效率和有效性通过研究现有的心理健康服务），并试图填补国家政策对SMI患者平等医疗保健的影响。