PROJECT SUMMARY
Medicaid is a key player in the care of individuals living with serious mental illness (SMI). Despite its high
costs, Medicaid-funded SMI care is characterized by low quality and inequities. Although state Medicaid
programs have implemented policies to improve quality or value of care for high-need beneficiaries including
those with SMI, policymakers lack the necessary information to develop, target, implement, and evaluate these
policies. For example, the associations between person- and area-level characteristics and quality of SMI care
are not well understood, precluding the targeting of corrective interventions. Moreover, concerns have been
raised about SMI quality measurement, with some arguing that available process-based indicators do not
cover key areas of SMI care and may not be associated with key patient outcomes, both health outcomes
(e.g., suicidality) and social outcomes (e.g., homelessness). Crucially, the quality and cost effects of the broad
adoption of telehealth to deliver mental health care following the COVID-19 pandemic are not well understood,
nor are its effects on disparities. Last, because little is known about the relationships between quality, health
and social outcomes, and Medicaid and other costs or their interplay with race/ethnicity, policymakers lack a
full understanding of the state budgetary and societal impacts of interventions to improve the quality and equity
of SMI care. Our proposed research seeks to fill these evidence gaps hindering policymakers’ efforts to
improve quality, equity, and value of SMI care. We will leverage an ongoing partnership with the New York
State Medicaid program’s mental health authority, availability of several patient-level datasets, and subject
matter and methods expertise. Aim 1 will identify person- and area-level predictors of quality of care and
determine if the associations vary by race/ethnicity. Aim 2 will estimate the effects of receipt of high-quality
care on health and social outcomes and determine if the effects vary by race/ethnicity. Aim 3 will estimate the
effects of telehealth on quality of mental health care and costs to Medicaid and determine if the effects vary by
race/ethnicity. Aim 4 will develop alternative quality-improving interventions and compare their effects on
health and social outcomes, Medicaid and broader state spending, and racial/ethnic equity. Our proposed
research is responsive to PAR-23-095 and aligned with the NIMH Strategic Plan’s Goal 4 because, among
other tasks, we will (a) identify mutable factors that are likely to influence disparities in quality and outcomes for
underserved groups, (b) use large representative data sets and novel computational approaches to improve
mental health care and its outcomes, and (c) evaluate the impacts of an innovation (telehealth). Successful
completion of our aims will provide policymakers with race/ethnicity-infused evidence regarding (a) groups to
be targeted for interventions to improve quality of care, (b) the effects of high-quality care on key patient
outcomes, (c) the effects of telemental health policies, and (d) the comparative effects of alternative quality-
improving interventions on outcomes of high significance to patients, state policymakers, and society.
