# Can the Medicare Quality Payment Program Incentivize Evidence-Based Treatment of Depression and Anxiety Disorders by Primary Care Providers?

> **NIH NIH R01** · SAINT LOUIS UNIVERSITY · 2021 · $321,150

## Abstract

Project Summary
Depression and anxiety disorders are common in patients in the primary care setting and have clear evidence-
based guidelines for screening, diagnosis, and treatment. However, rates of screening and treatment among
Medicare beneficiaries remain low. Without proper treatment, these patients may experience persistent
depression and anxiety symptoms, difficulty co-managing other conditions, worsening functional status, and
avoidable and expensive acute medical events. In 2017, Medicare launched the Quality Payment Program
(QPP) to incentivize delivery of high quality, low cost, evidence-based care in the outpatient setting. Primary
care providers (PCPs) are required to participate in the QPP via one of two tracks: 1) the Merit-Based Incentive
Payment System (MIPS), the default track; or 2) alternative payment models (APMs) such as accountable care
organizations (ACOs) and patient-centered medical homes (PCMHs). In the both the APMs and MIPS, PCPs
are paid for their performance based on the quality and cost of care they deliver to patients. However, the
effects of these QPP models on treatment of depression and anxiety disorders by PCPs are unknown. There is
a critical need for research on the effects of the APMs and MIPS on access to care and delivery of evidence-
based treatment for depression and anxiety disorders in the primary care setting, as well as subsequent
outcomes for patients. Our scientific premise is that the QPP, which is a program targeted at the general
patient population, has conflicting incentives for primary care delivery to patients with depression and anxiety
disorders. On one hand, the QPP incentivizes PCPs in ACOs and PCMHs to adopt innovative care models that
may increase rates of evidence-based treatment. However, on the other hand, the QPP does not risk adjust for
the most prevalent types of depression and anxiety disorders, which creates a financial disincentive to PCPs in
ACOs and PCMHs for caring for patients with these conditions, potentially threatening their access to care.
This negative consequence may be further magnified among patients who are poor, belong to racial and/or
ethnic minority groups, or live in rural areas. The objective of this R01 application is to conduct a longitudinal
study linking rich national datasets of Medicare claims, patient surveys, and PCP data from 2017-2022 to
evaluate: 1) patient and PCP risk selection into the APMs vs. MIPS (Aim #1); 2) whether financial incentives to
PCPs in the QPP contribute to this risk selection and how they may be remedied (Aim #2); and 3) the effect of
patient care from PCPs in the APMs vs. MIPS on delivery of evidence-based treatment for depression and
anxiety disorders and subsequent patient outcomes (Aim #3). We hypothesize that although patients with
depression and anxiety disorders will receive higher rates of evidence-based treatment and have better
outcomes when treated by PCPs participating in the APMs vs. MIPS, these patients will none...

## Key facts

- **NIH application ID:** 10366446
- **Project number:** 1R01MH125820-01A1
- **Recipient organization:** SAINT LOUIS UNIVERSITY
- **Principal Investigator:** Kenton James Johnston
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $321,150
- **Award type:** 1
- **Project period:** 2021-09-07 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10366446

## Citation

> US National Institutes of Health, RePORTER application 10366446, Can the Medicare Quality Payment Program Incentivize Evidence-Based Treatment of Depression and Anxiety Disorders by Primary Care Providers? (1R01MH125820-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10366446. Licensed CC0.

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