The quality of care delivered to patients with serious mental illness (SMI) lags well behind the potential to treat these patients, given an array of efficacious evidence-based treatments available. Fragmentation of care and rigid, poorly aligned payment approaches contribute to inadequate physical and mental health care for patients with SMI. New contracting and payment strategies aim to increase the quality and value of care for patients with SMI using financial incentives and explicit quality of care benchmarks. These emerging strategies hold promise for increasing the efficiency and effectiveness of care for patients with SMI, one of the objectives in the 2015 NIMH Strategic Plan for Research. Despite increasing adoption of new payment strategies by public insurers, which insure a disproportionate share of patients with SMI, scant evidence describes whether and how these changes are linked to quality of care and outcomes for this vulnerable group, and even less is known about contract or organization features that may improve quality of care for patients with SMI. New health care payment and delivery contracts have many goals: encouraging coordination of care, promoting delivery of care in the most appropriate setting, improving population health, and containing health care costs. In this proposed research, using the start date of novel payment contracts, we will 1) examine how emerging contracts between providers and insurers address health care for patients with SMI; 2) estimate how the quality of care and outcomes for patients with SMI change with payment contract designs and organizational strategies; and 3) estimate how population health measures are associated with contract designs and organizational strategies targeting physical and mental health care for people with mental illness. To complete the research, we will develop and field a mental healthfocused wave of an ongoing survey of health care provider organizations (Aim 1). We will link these new survey data on contract designs and mental health-specific organizational strategies to patient-level administrative claims data (Aims 2 and 3) to better understand the implications of emerging contracts for quality of care and population health outcomes for people with SMI. The proposed research will help to tailor emerging payment contracts and organizational strategies to meet the needs of populations with mental illness.
The proposed research will examine how provider organizations respond to the physical and mental health needs of patients with mental illness when operating under novel payment contracts that aim to increase the quality and value of care for patients with mental illness using financial incentives and explicit quality of care benchmarks. By linking new data on mental health-specific features of contract designs and organizational approaches to administrative data on quality of care and outcomes for patients with mental illness, we will learn whether new contracts and organizational innovations facilitate or hinder broad and effective delivery of health care to this population. This knowledge will enable us to tailor contracts and organizational strategies to better meet the complex care needs of people with mental illness.
