Addressing Gaps in the Evidence to Improve Quality and Value of Serious Mental Illness Care in Medicaid

PROJECT SUMMARY Medicaid is a key player in the care of individuals living with serious mental illness (SMI). Despite its high costs, Medicaid-funded SMI care is characterized by low quality, particularly among socially disadvantaged beneficiaries. Although state Medicaid programs have implemented policies to improve quality or value of care for high-need beneficiaries including those with SMI, policymakers lack the necessary information to develop, target, implement, and evaluate these policies. For example, the associations between person- and area-level characteristics and quality of SMI care are not well understood, precluding the targeting of corrective interventions. Moreover, concerns have been raised about SMI quality measurement, with some arguing that available process-based indicators do not cover key areas of SMI care and may not be associated with key patient outcomes, both health outcomes (e.g., suicidality) and social outcomes (e.g., homelessness). Crucially, the quality and cost effects of the broad adoption of telehealth to deliver mental health care are not well understood. Last, because little is known about the relationships between quality, health and social outcomes, and Medicaid and other costs, or their interplay with social disadvantage, policymakers lack a full understanding of the state budgetary and societal impacts of interventions to improve the quality of care for all beneficiaries with SMI. Our proposed research seeks to fill these evidence gaps hindering policymakers’ efforts to improve quality and value of SMI care. We will leverage an ongoing partnership with the New York State Medicaid program’s mental health authority, availability of several patient-level datasets, and subject matter and methods expertise. Aim 1 will identify person- and area-level predictors of quality of care and determine if the associations vary by social disadvantage. Aim 2 will estimate the effects of receipt of high-quality care on health and social outcomes and determine if the effects vary by social disadvantage. Aim 3 will estimate the effects of telehealth on quality of mental health care and costs to Medicaid. Aim 4 will develop alternative quality-improving interventions and compare their effects on health and social outcomes, and Medicaid and broader state spending. Our proposed research is responsive to PAR-25-283 and aligned with Goal 4 of the NIMH Strategic Plan because, among other tasks, we will identify mutable factors that are likely to influence disparities in quality and outcomes for underserved groups. Moreover, we will use large representative data sets and novel computational approaches to improve mental health care and its outcomes, and (c) evaluate the as yet poorly understood impacts of telehealth. Successful completion of our aims will provide policymakers with evidence regarding (a) groups to be targeted for interventions to improve quality of care, (b) the effects of high-quality care on key patient outcomes, (c) the effects of telemental health policies, and (d) the comparative effects of alternative quality-improving interventions on outcomes of high significance to patients, state policymakers, and society.