Impact of the New York State Medicaid Value-Based Payment Policy on Opioid Use Disorder Treatment - PROJECT SUMMARY - Value-Based Payment (VBP), which incentivizes care quality and service efficiency instead of volume-based care, remains under-studied concerning populations with behavioral health disorders. Additionally, little to no research assesses VBP effects on disparities. The sparse literature primarily targets broad categorizations of substance use disorder and findings rarely extend to specific conditions, such as opioid use disorder (OUD). In light of OUD’s burden on individuals and society, there is a critical need to identify healthcare initiatives that can improve OUD treatment and optimize care delivery for all races and ethnicities. Our overarching objective is to exploit a natural experiment and assess the overall causal impact of New York State’s (NYS) Medicaid VBP initiative and its effects on disparities in OUD-related outcomes including service use, quality, opioid overdose, and resource allocation. Additionally, we will evaluate the influence of measurable individual- (e.g., chronic comorbidities), area- (e.g., provider supply), and system-level (e.g., provider risk level variation within VBP arrangements) factors on OUD-related outcomes. Our central hypothesis is that VBP will improve access, quality, and effectiveness, while optimizing resource allocation. Findings from alternative payment models and expert opinion support this hypothesis. The rationale for the proposed research is that understanding the outcomes of NYS Medicaid VBP model will yield actionable evidence to improve hospital practice, inform provider involvement, and enhance patient care. The central hypothesis will be tested by pursuing the following three aims: 1) Assess the overall causal impact of NYS Medicaid VBP model on OUD-related outcomes, including service use (any OUD service use, any MOUD), quality (MOUD initiation/engagement/retention, follow–up after ED visit for OUD, OUD hospital readmission, hepatitis-C virus screening), opioid-related overdose (non-fatal/fatal), and costs (total and component); 2) Determine the efficacy of NYS Medicaid VBP model as a solution-oriented mechanism to address measurable disparities in OUD-related outcomes; and 3) Examine whether measurable individual-, area-, and system-level factors moderate the effects in Aims 1-2, and assess provider risk-level as a potential mediator/suppressor of VBP impact. We have selected aims and outcomes that prioritize clinical impact and public health utility. To complete these aims, we will use longitudinal, real-world Medicaid data linked to area-level and death certificate data and employ a robust quasi-experimental research design, which allows for causal inferences. Results will fill a critical evidence gap regarding Medicaid VBP effects among high-need OUD beneficiaries, providing valuable, actionable information to hospitals, clinics, and providers to optimize patient care delivery.
