Abstract

Thequalityofcaredeliveredtopatientswithseriousmentalillness(SMI)lagswellbehindthepotentialtotreat thesepatients,givenanarrayofefficaciousevidence-basedtreatmentsavailable.Fragmentationofcareand rigid,poorlyalignedpaymentapproachescontributetoinadequatephysicalandmentalhealthcareforpatients withSMI.Newcontractingandpaymentstrategiesaimtoincreasethequalityandvalueofcareforpatients withSMIusingfinancialincentivesandexplicitqualityofcarebenchmarks.Theseemergingstrategieshold promiseforincreasingtheefficiencyandeffectivenessofcareforpatientswithSMI,oneoftheobjectivesin the2015NIMHStrategicPlanforResearch.Despiteincreasingadoptionofnewpaymentstrategiesbypublic insurers,whichinsureadisproportionateshareofpatientswithSMI,scantevidencedescribeswhetherand howthesechangesarelinkedtoqualityofcareandoutcomesforthisvulnerablegroup,andevenlessis knownaboutcontractororganizationfeaturesthatmayimprovequalityofcareforpatientswithSMI.New healthcarepaymentanddeliverycontractshavemanygoals:encouragingcoordinationofcare,promoting deliveryofcareinthemostappropriatesetting,improvingpopulationhealth,andcontaininghealthcarecosts. Inthisproposedresearch,usingthestartdateofnovelpaymentcontracts,wewill1)examinehowemerging contractsbetweenprovidersandinsurersaddresshealthcareforpatientswithSMI;?2)estimatehowthe qualityofcareandoutcomesforpatientswithSMIchangewithpaymentcontractdesignsandorganizational strategies;?and3)estimatehowpopulationhealthmeasuresareassociatedwithcontractdesignsand organizationalstrategiestargetingphysicalandmentalhealthcareforpeoplewithmentalillness.Tocomplete theresearch,wewilldevelopandfieldamentalhealth-focusedwaveofanongoingsurveyofhealthcare providerorganizations(Aim1).Wewilllinkthesenewsurveydataoncontractdesignsandmentalhealth- specificorganizationalstrategiestopatient-leveladministrativeclaimsdata(Aims2and3)tobetterunderstand theimplicationsofemergingcontractsforqualityofcareandpopulationhealthoutcomesforpeoplewithSMI. Theproposedresearchwillhelptotailoremergingpaymentcontractsandorganizationalstrategiestomeetthe needsofpopulationswithmentalillness.

Public Health Relevance

Theproposedresearchwillexaminehowproviderorganizationsrespondtothephysicalandmentalhealth needsofpatientswithmentalillnesswhenoperatingundernovelpaymentcontractsthataimtoincreasethe qualityandvalueofcareforpatientswithmentalillnessusingfinancialincentivesandexplicitqualityofcare benchmarks.Bylinkingnewdataonmentalhealth-specificfeaturesofcontractdesignsandorganizational approachestoadministrativedataonqualityofcareandoutcomesforpatientswithmentalillness,wewilllearn whethernewcontractsandorganizationalinnovationsfacilitateorhinderbroadandeffectivedeliveryofhealth caretothispopulation.Thisknowledgewillenableustotailorcontractsandorganizationalstrategiestobetter meetthecomplexcareneedsofpeoplewithmentalillness.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH109531-01A1
Application #
9237825
Study Section
Mental Health Services Research Committee (SERV)
Program Officer
Rupp, Agnes
Project Start
2016-09-26
Project End
2020-06-30
Budget Start
2016-09-26
Budget End
2017-06-30
Support Year
1
Fiscal Year
2016
Total Cost
$744,877
Indirect Cost
$271,328

  Institution

Name
Dartmouth College
Department
Type
Schools of Medicine
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755