Improving Minority Health by Monitoring Medicaid Quality, Disparities and Value

PROJECT Summary: Schizophrenia is a serious mental illness associated with a high burden of disease due to severe disability andpremature mortality largely driven by co-occurring chronic medical conditions that shorten life expectancy by atleast 20 years. The broad array of services needed by this population are primarily financed by Medicaid.Despite high costs, most patients do not receive recommended care, and minorities are less likely to do sothan whites. These pre-existing disparities and the profound social disadvantage also experienced by thispopulation make them particularly vulnerable to the devastation caused by the COVID-19 pandemic, which inthe US has been particularly severe in the state of New York. New Yorkers with schizophrenia, and minoritiesin particular, are not only a high-risk group for poorer COVID-19 outcomes but they may also experiencedeclines in their health due to disruptions in their ability to access healthcare. Although New York's Medicaidprogram authorized the use of telehealth to mitigate those disruptions soon after the Governor declared a Stateof Emergency in early March 2020, the degree to which telehealth has been adopted by Medicaid providersserving seriously mentally ill people and whether the effects of telehealth adoption may vary by race/ethnicityare not well known. Our proposed administrative supplement application builds on our ongoing NIMHD-fundedparent study (MD012428), which seeks to reduce healthcare disparities and thus improve health outcomes ofracial/ethnic minority populations through measurement of quality disparities and value (or cost-effectiveness)of Medicaid-financed care delivered to adults with schizophrenia. Consistent with the NIMHD's Notice ofSpecial Interest calling for studies of the impact of the COVID-19 outbreak on health disparity populations, wepropose to evaluate the effects of the outbreak on the racially/ethnically diverse population of Medicaidbeneficiaries with schizophrenia living in New York. In Aim 1, we will assess the effect of the outbreak onracial/ethnic disparities in access, quality, and effectiveness of mental and physical healthcare delivered to ourstudy population. In Aim 2, we will assess Medicaid providers' responses to the outbreak and their effects onhealthcare disparities in our study population. We will characterize provider response through a measure ofprovider readiness to adopt telehealth. Our general approach to assessing the impact of the outbreak onhealthcare outcomes and the impact of provider responses on those outcomes will involve the use of post-preoutbreak differences, interrupted time series approaches, as well as approaches that utilize time-varyingcoefficients. In all analyses, our primary interest are parameters that describe how race/ethnicity moderates theoutbreak's effect on outcomes and the providers' responses on outcomes. We expect that our work will providepolicymakers with a better understanding of the impacts of the outbreak on vulnerable populations and enablethe design of more effective policies to address this and future crises.