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The Role of Insurance Networks and Organizational Factors in Guideline-Concordant Care for Serious Mental Illness

Award Number: R34MH123628
ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/13/2021
PERIOD OF PERFORMANCE END DATE: 06/30/2025

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The Role of Insurance Networks and Organizational Factors in Guideline-Concordant Care for Serious Mental Illness - PROJECT SUMMARY Serious mental illness affects more than 5% of the United States population, but only a small proportion of these individuals receive adequate treatment. Schizophrenia impacts one percent of the population and is particularly debilitating. Individuals with schizophrenia have high rates of poor health and social outcomes, including premature mortality, homelessness, and substance use. Individuals with schizophrenia are at increased risk of suicide and have high rates of comorbid disease. Guideline-concordant care (GCC) – including appropriate medications and psychotherapy – improves outcomes for individuals with schizophrenia, including mortality. However, rates of GCC are low, with significant variation across patient demographic groups, clinical conditions, and clinician types. Although some differences may be explained by patient preferences, system factors at the insurance and organization levels likely contribute to low rates of GCC. Better understanding system factors – including the role of insurance networks and organizations – that help guide treatment pathways towards GCC and improve patient outcomes is an important contribution to improving clinical practice for individuals living with schizophrenia. Pursuant to the goals of PAR-19-189, the objective of this pilot services research is to identify mutable health care system factors related to access and quality of mental health services. Using comprehensive health insurance enrollment and claims data from Massachusetts we quantify and examine variation in insurance networks for those with schizophrenia, examine associations of these network characteristics – including size and composition (reflecting availability of mental health clinicians) – with patient outcomes of guideline-concordant care receipt and self-harm. As a potential mechanism for understanding how insurance networks may influence patient outcomes, we examine associations of organizational characteristics – organization size and proportion of mental health clinicians – with patient outcomes. We conduct sensitivity analyses limiting to individuals with first episode psychosis due to the clinical urgency of comprehensive care and policy interest in this population, and establish a causal relationship between insurance networks and organizations and outcomes using a young adult sample. Understanding factors associated with GCC and outcomes will help identify effective policy levers to improve care. Findings from this pilot study will guide future improvements in mental health services delivery, as well as identify avenues for future research on policy changes influencing critical system characteristics.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2023	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Mental Health Research Grants	003	4	2/25/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$258,414
2025	2023	UNIVERSITY OF MASSACHUSETTS	101 COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Mental Health Research Grants	002	3	2/25/2025	NON-COMPETING CONTINUATION	-$1
2025	2022	UNIVERSITY OF MASSACHUSETTS	101 COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Mental Health Research Grants	001	2	2/25/2025	NON-COMPETING CONTINUATION	-$239,250
2025	2021	UNIVERSITY OF MASSACHUSETTS	101 COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Mental Health Research Grants	000	1	2/25/2025	NEW	-$19,163
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = -$2,249 )
2024	2023	UNIVERSITY OF MASSACHUSETTS	101 COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Mental Health Research Grants	000	3	7/29/2024	NON-COMPETING CONTINUATION	-$239,249
2024	2023	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Mental Health Research Grants	001	4	7/30/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$237,000
														Subtotal = -$2,249

Issue Date FY: 2023 ( Subtotal = $239,250 )
2023	2023	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Mental Health Research Grants	000	3	7/13/2023	NON-COMPETING CONTINUATION	$239,250
														Subtotal = $239,250

Issue Date FY: 2022 ( Subtotal = $239,250 )
2022	2022	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Mental Health Research Grants	000	2	7/8/2022	NON-COMPETING CONTINUATION	$239,250
														Subtotal = $239,250

Issue Date FY: 2021 ( Subtotal = $239,250 )
2021	2021	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Mental Health Research Grants	000	1	8/12/2021	NEW	$239,250
2021	2021	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Mental Health Research Grants	001	1	9/9/2021	NEW	$0
														Subtotal = $239,250

Grand Total All Awards = $715,501

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The Role of Insurance Networks and Organizational Factors in Guideline-Concordant Care for Serious Mental Illness

Award Number: R34MH123628

ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/13/2021

PERIOD OF PERFORMANCE END DATE: 06/30/2025

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