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.
To address mental health care access challenges, recent federal legislation guarantees basic financial protections for mental health care on a parity with medical benefits. However, the intended outcomes from such legislation may be difficult to achieve because health plan features that are critical for access parity, such as provider networks, are poorly understood. The overarching objective of this application is to understand what features of mental health provider networks can improve care utilization and clinical outcomes for beneficiaries in Medicaid, one of the largest payers of mental health care in the U.S.
