Project Summary/Abstract
Medicaid patients experience significant health inequities. Medicaid patients have worse access to primary
care, which leads to adverse health events and utilization of high-cost services. Medicaid behavioral health
(BH) patients face even worse outcomes. Medicaid BH patients have higher rates of comorbid physical illness,
and have four times higher spending and mortality rates than those without a BH diagnosis. Medicaid BH
patients require complex clinical coordination, making care integration across delivery settings an urgent
policy goal. In an effort to improve utilization and health outcomes for BH patients, Medicaid programs across
the country are using pay-for-performance (P4P) to enact delivery system reform. P4P payment programs
reimburse health providers for achieving quality process and outcome milestones instead of services volume.
In 2014, New York (NY) Medicaid established a program by which health providers were paid using P4P in
order to finance delivery reform initiatives. P4P may especially benefit BH patients, whose complex care needs
coordination and increased quality standardization. There is a growing push for states to adopt Medicaid P4P,
yet the impact of P4P programs have not been rigorously studied within Medicaid, especially in the context of
behavioral health care. This study investigates if Medicaid P4P reform is effective at improving health
outcomes and utilization for patients with unipolar depression, bipolar depression, and schizophrenia. We will
use a difference-in-differences (DiD) analysis to compare utilization and outcomes of Medicaid BH patients
receiving care from providers receiving P4P incentives to utilization and outcomes of Medicaid BH patients
receiving care from providers without P4P incentives. In NY’s P4P program, about 70% of all Medicaid primary
care providers participated in geographically diverse settings, enabling construction of exposed and
unexposed Medicaid BH to payment reform. Descriptive statistics and preliminary results on outcomes will be
presented. Analytic issues will be discussed, including approaches to address potential bias and group
comparability such as propensity score weights. This proposal also includes a detailed description of my
training plan, including scientific and career development training, as well as details on the excellent training
environment of NYU Grossman School of Medicine’s MSTP program.
