PROJECT SUMMARY
Treating individuals with schizophrenia requires a broad array of services, including physical health care
services, which are primarily financed by Medicaid. Despite high health care costs, most patients do not
receive recommended care, and minorities are less likely to do so than whites. Moreover, where patients live
matters, with quality and quality disparities varying not just among states but also among counties within
states. At a time of reform and fiscal constraint, Medicaid programs are challenged with improving quality and
reducing quality disparities among high-needs beneficiaries, including those with schizophrenia, at no extra
costs. Factors likely to impact a program’s success include its ability to 1) comprehensively measure quality of
care, capturing key domains of both mental health and physical health care, 2) validly and feasibly measure
the value of care routinely delivered to their beneficiaries, and importantly, 3) incorporate racial/ethnic
disparities in the assessment of value. Such measurement efforts should be undertaken at the level of
meaningful geographic units such as counties, where patterns of health care are influenced by policies
reflecting both state and local priorities. In response to FOA 16-221, we propose a program of research that
seeks to reduce health disparities and improve the health of minority populations served in publicly funded
settings through measurement of quality disparities and other critical domains of Medicaid-financed care
delivered to adults with schizophrenia living in five diverse states. We will measure quality using evidence-
based indicators, and exploiting psychometric principles, we will create an overall composite score as well as
key sub-scores. Using the composite measure, we will assess racial/ethnic and geographic disparities in
overall quality of care; value, defined as the cost to the Medicaid state program of producing high-quality care;
and the cost to the program of eliminating racial/ethnic disparities in quality. We will integrate quality and costs
through a unique cost-effectiveness methodology, and to our knowledge, our work will be the first to
quantitatively link disparities and costs of serious mental illness care. Our ultimate goal is to provide
policymakers with a user-friendly interactive tool to monitor quality, quality disparities, costs, and value, thus
enabling evidence-based policymaking. Aim 1 will assess racial/ethnic and geographic disparities in quality of
mental health, physical health, and overall health care routinely delivered to beneficiaries with schizophrenia.
Aim 2 will develop and implement a cost-effectiveness framework to assess value, operationalized as the
incremental net monetary benefit of care. Aim 3 will use the statewide white population as a reference
standard to determine the cost of eliminating racial/ethnic quality disparities in each county. Aim 4 will develop
and pilot a user-friendly interactive tool to enable state Medicaid programs to monitor quality, disparities, costs,
and value of care. We expect that the proposed research will contribute to the eradication of disparities through
advanced performance measurement techniques that will enable routine monitoring of Medicaid care.