# Medicaid Value Based Payment Models and Healthcare Equity for Adults with Serious Mental Illnesses

> **NIH NIH R01** · CAMBRIDGE HEALTH ALLIANCE · 2022 · $682,523

## Abstract

Project Summary/Abstract
In order to improve health outcomes while reducing costs, Medicaid Value Based Payment
(VBP) models reward providers for quality. Early evidence from state agencies suggests that
Medicaid VBP models had moderate success in meeting their health and economic targets for
the average beneficiary. However, despite the fact Medicaid is a critical payer for costly
healthcare needed by adults with Serious Mental Illness (SMI), little is known about VBP effects
on Medicaid beneficiaries with SMI, especially those belonging to racial/ethnic minority groups.
Our research team and others have documented significant disparities in access, quality, and
outcomes of healthcare for Black and Latino relative to White adults with SMI. We and others
have also shown that policies with average beneficial effects for people with mental illnesses
may not benefit everyone equally—e.g., we demonstrated that while the Affordable Care Act
improved access to mental healthcare, it had no impact on the wide racial/ethnic disparities in
access to mental health treatment. The challenges of navigating service delivery changes in
VBP may be greater for people with SMI and for minority patients due to poorer baseline
healthcare access and quality and their greater social disadvantage. A lack of data on the
equity impacts of VBP for racial/ethnic minorities with SMI is a crucial evidentiary gap.
We propose to evaluate the impact of VBP models on racial/ethnic disparities in mental health
treatment among patients with SMI. We will use longitudinal 2010-2019 Medicaid claims from
Oregon and New York, two states that have implemented hybrid VBP models targeting both
providers and managed care organizations, and link these data to national provider data and
area-level characteristics. For each state, we evaluate (a) the overall impact of VBP models as
well as (b) investigate the impact of different VBP models within states (i.e., the differential
impact on disparities attributed to variation in how managed care organizations contracted with
providers). Our primary analyses estimate the differential impact of VBP implementation, among
Medicaid beneficiaries with SMI, by race/ethnicity (White, Black, or Hispanic/Latino) for
healthcare: (Aim 1) access, (Aim 2) quality, (Aim 3) effectiveness, and (Aim 4) costs.
The proposed research will provide meaningful evidence to states considering VBP adoption. It
is consistent with NIMH Strategic Objective 4.1 (Improve the efficiency and effectiveness of
existing mental health services through research), and seeks to fill the evidentiary gap in the
effects of state policies on equitable health care for individuals living with SMI.

## Key facts

- **NIH application ID:** 10371072
- **Project number:** 5R01MH122199-03
- **Recipient organization:** CAMBRIDGE HEALTH ALLIANCE
- **Principal Investigator:** Benjamin Le Cook
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $682,523
- **Award type:** 5
- **Project period:** 2020-02-14 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10371072

## Citation

> US National Institutes of Health, RePORTER application 10371072, Medicaid Value Based Payment Models and Healthcare Equity for Adults with Serious Mental Illnesses (5R01MH122199-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10371072. Licensed CC0.

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