Schizophrenia is a serious mental illness associated with a high burden of disease due to severe disability and premature mortality largely driven by co-occurring chronic medical conditions that shorten life expectancy by at least 20 years. The broad array of services needed by this population are primarily financed by Medicaid. Despite high costs, most patients do not receive recommended care, and minorities are less likely to do so than whites. These pre-existing disparities and the profound social disadvantage also experienced by this population make them particularly vulnerable to the devastation caused by the COVID-19 pandemic, which in the US has been particularly severe in the state of New York. New Yorkers with schizophrenia, and minorities in particular, are not only a high-risk group for poorer COVID-19 outcomes but they may also experience declines in their health due to disruptions in their ability to access healthcare. Although New York?s Medicaid program authorized the use of telehealth to mitigate those disruptions soon after the Governor declared a State of Emergency in early March 2020, the degree to which telehealth has been adopted by Medicaid providers serving seriously mentally ill people and whether the effects of telehealth adoption may vary by race/ethnicity are not well known. Our proposed administrative supplement application builds on our ongoing NIMHD-funded parent study (MD012428), which seeks to reduce healthcare disparities and thus improve health outcomes of racial/ethnic minority populations through measurement of quality disparities and value (or cost-effectiveness) of Medicaid-financed care delivered to adults with schizophrenia. Consistent with the NIMHD?s Notice of Special Interest calling for studies of the impact of the COVID-19 outbreak on health disparity populations, we propose to evaluate the effects of the outbreak on the racially/ethnically diverse population of Medicaid beneficiaries with schizophrenia living in New York.
In Aim 1, we will assess the effect of the outbreak on racial/ethnic disparities in access, quality, and effectiveness of mental and physical healthcare delivered to our study population.
In Aim 2, we will assess Medicaid providers? responses to the outbreak and their effects on healthcare disparities in our study population. We will characterize provider response through a measure of provider readiness to adopt telehealth. Our general approach to assessing the impact of the outbreak on healthcare outcomes and the impact of provider responses on those outcomes will involve the use of post-pre outbreak differences, interrupted time series approaches, as well as approaches that utilize time-varying coefficients. In all analyses, our primary interest are parameters that describe how race/ethnicity moderates the outbreak?s effect on outcomes and the providers? responses on outcomes. We expect that our work will provide policymakers with a better understanding of the impacts of the outbreak on vulnerable populations and enable the design of more effective policies to address this and future crises.
The proposed supplemental research has high public health relevance because we propose to study the impact of the COVID-19 outbreak on the healthcare received by adult Medicaid beneficiaries with schizophrenia, a socially disadvantaged population with a high disease burden whose care has been shown to be of low quality and in addition, encumbered by racial/ethnic disparities. We seek to assess disparities in quality of both mental and physical healthcare and also access and effectiveness of healthcare, and evaluate providers? use of telehealth and the effect of telehealth adoption on preexisting racial/ethnic disparities. We expect that our work will allow policymakers to gain a better understanding of the impacts of the COVID-19 outbreak and enable the design of more effective policies to address this and future crises.
