Impact of the New York State Medicaid Value-Based Payment Model on Opioid Use Treatment and Equity - PROJECT SUMMARY _RY_ ____ _ Value-Based Payment (VBP) policy, which incentivizes care quality and cost savings instead of volume-based care, remains under-studied concerning populations with behavioral health disorders. Moreover, little is known about VBP policy effects within Medicaid or its impact on equity. The sparse literature primarily targets broad categorizations of substance use disorder and findings rarely extend to specific disorders, such as opioid use disorder (OUD). In light of OUD's burden on individuals and society, there is a critical need to identify policy levers that can improve OUD treatment and value of care for all races and ethnicities. The long-term goal is to identify health policies that can improve healthcare inequities among persons with OUD. The overarching objective of this proposal is to exploit a natural experiment and assess the causal impact of NYS Medicaid VBP policy and examine the policy's equity effects on OUD-related outcomes (service use, quality, overdose, and healthcare costs). Because factors at different levels may alter the policy's effects, we will also evaluate the influence of individual- (e.g., comorbidities), area- (e.g., provider supply), and policy-level (e.g., VBP provider risk-level) factors on OUD-related outcomes. The rationale for the proposed research is that understanding the outcomes of NYS Medicaid VBP policy will inform and guide policymakers as well as states implementing similar initiatives. We will pursue the following specific aims: 1) Assess the overall causal impact of NYS Medicaid VBP policy 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, 30-day OUD hospital readmission, and hepatitis-C virus screening), opioid-related overdose (non-fatal/ fatal), and costs (total and component); 2) Determine the equity effect of NYS Medicaid VBP policy on OUD-related outcomes, including service use, quality, overdose, and costs; and 3) Examine whether individual-, area-, and policy-level factors moderate the effects in Aims 1-2, and provider risk-level as a potential mediator/ suppressor of VBP impact. Building on our partnership with the NYS Department of Health, we have selected aims and outcomes that align with NYS Medicaid Program priorities. To complete these aims, we will use longitudinal 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 policy effects among vulnerable and high-need beneficiaries, providing valuable evidence to VBP states and those considering VBP adoption. Work from this proposal will be shared with stakeholders and policy officials in NYS to inform the ongoing implementation of their VBP policy.
