Medicaid Delivery System Reform Incentive Payment (DSRIP) Programs: Impacts on Health Care Use, Coordination, Outcomes, and Disparities among Patients with Mental Illness - PROJECT SUMMARY As the largest payer for mental health care in the United States, Medicaid is adopting value-based payment models that link provider payments to quality in an effort to improve outcomes for high-need populations, including individuals with a serious mental illness (SMI). With over $55 billion in joint state and federal funding, Medicaid Delivery System Reform Incentive Payment (DSRIP) programs represent the most extensive effort to implement value-based payment in Medicaid to date. In DSRIP programs, which often emphasize mental health care, states contract with providers to participate in performance-based incentive payment projects, with the goal of encouraging health systems to invest in care coordination, improve surveillance of Medicaid enrollees’ care needs and outcomes, and invest in services to address enrollees’ mental health and general medical care needs. Thirteen states have implemented DSRIP programs to date. However, national evidence on the impacts of DSRIP programs on patients with SMI is lacking, both overall and for sociodemographic subgroups at high risk of experiencing poor care and outcomes. Furthermore, there is limited evidence about which features of DSRIP programs yield positive benefits—critical to understand as key program elements vary across states. The proposed study will address these evidence gaps by evaluating the impacts of DSRIP programs among community-dwelling Medicaid enrollees with a diagnosis of major depression, bipolar disorder, or schizophrenia. Using national Medicaid claims and encounter data and a difference-in-differences design, the project has three Aims: 1) to investigate the impacts of DSRIP programs on outpatient mental health and primary care use and health care quality measures indicative of care coordination and health outcomes for Medicaid enrollees with SMI; 2) examine heterogeneity in the impacts of DSRIP programs among subgroups of Medicaid enrollees with SMI along the dimensions of race/ethnicity, health complexity, disability status, and rurality; and 3) identify specific DSRIP programmatic features that are associated with positive impacts on Medicaid enrollees with SMI, leveraging variation across states in DSRIP program design. Because DSRIP programs are time-limited but intended to initiate enduring delivery system improvements, analyses will also assess longer-term impacts among Medicaid-enrolled populations with SMI. This project aligns with NIMH’s Strategic Plan to compare alternative financing models to improve care for patients with SMI and approaches to reduce documented disparities in care access, quality, and outcomes for disadvantaged subpopulations (Strategies 4.1.C and 4.3.A). Findings will provide critical evidence to guide future Medicaid payment and delivery system reforms to improve the quality and equity of health care for individuals with SMI. To maximize this project’s impact, we will work with a Policy Advisory Council comprising experts in Medicaid mental health policy from the government, research, and insurance sectors, building on our team’s track record of translating health services research to inform policy.
