By OPEN MINDS Circle
After New York state implemented value-based payment (VBP) reform for behavioral health services in 2015, state Medicaid beneficiaries had more outpatient visits and fewer emergency department (ED) visits. The number of outpatient visits for those diagnosed with depression increased by 0.91 visits per year, and increased by 1.01 visits per year for those with bipolar disorder. ED visits per year declined by 0.01 visits among those with depression, 0.02 visits among those with bipolar disorder, and 0.04 visits among those with schizophrenia.
The stateās VBP reform was part of its Medicaid Delivery System Reform Incentive Payment (DSRIP) program, which went into effect on July 1, 2015. New Yorkās DSRIP program created 25 provider networks (similar to accountable care organizations), each with outpatient practices and hospitals. The networks implemented a variety of population-specific or systemwide delivery reform projects that had milestones for specific measures. All DSRIP networks were required to implement at least one behavioral health project, such as integrating medical and mental health care.
The network members were reimbursed at regular contract rates, either fee-for-service by the state or with Medicaid managed care organizations. For the VBP reform, the network members were eligible to share in pay-for-performance bonuses earned if the DSRIP network met project milestones on the specific measures. The analysis of beneficiary utilization patterns spanned July 1, 2013, through June 30, 2019, which covered the two years before and the four years after provider organizations participated in the DSRIP VBP implementation.
| Change In Outpatient Behavioral Health Utilization After VBP, By Diagnosis, For Beneficiaries Attributed To VBP Practices, New York Medicaid | ||||
| VBP Practices | Non-VBP Practices | |||
| Diagnosis | Mean Annual Visits Before VBP | Mean Annual Visits After VBP | Mean Annual Visits Before VBP | Mean Annual Visits After VBP |
| Depression | 3.6 | 5.8 | 3.9 | 5.3 |
| Bipolar Disorder | 6.1 | 9.0 | 6.7 | 8.6 |
| Schizophrenia | 8.0 | 9.4 | 7.8 | 9.1 |
| Change In Inpatient & Emergency Department (ED) Behavioral Health Utilization After VBP, By Diagnosis, For Beneficiaries Attributed To VBP Practices, New York Medicaid | ||||
| VBP Practices | Non-VBP Practices | |||
| Diagnosis | Mean Annual Visits Before VBP | Mean Annual Visits After VBP | Mean Annual Visits Before VBP | Mean Annual Visits After VBP |
| Depression, Hospitalization | 0.08 | 0.06 | 0.06 | 0.06 |
| Depression, ED | 0.08 | 0.09 | 0.06 | 0.08 |
| Bipolar Disorder, Hospitalization | 0.23 | 0.17 | 0.22 | 0.17 |
| Bipolar Disorder, ED | 0.19 | 0.22 | 0.17 | 0.22 |
| Schizophrenia, Hospitalization | 0.33 | 0.25 | 0.34 | 0.26 |
| Schizophrenia, ED | 0.26 | 0.29 | 0.23 | 0.29 |
These findings were reported in āMedicaid Value-Based Payments and Health Care Use for Patients With Mental Illnessā by Ashley Lewis, BS; Renata E. Howland, Ph.D.; Leora I. Horwitz, M.D.; and Sunita M. Desai, Ph.D. The researchers analyzed changes in utilization for nearly 50,000 adult New York state Medicaid beneficiaries with major depression disorder (306,290), bipolar disorder (85,105), and/or schizophrenia (71,299) who used mental health services between July 1, 2013, and June 30, 2019. They analyzed administrative claims and encounter data for all managed care and fee-for-service beneficiaries.
The analysis focused on differences in utilization by beneficiaries who received services from an outpatient behavioral health practice from July 1, 2013, through June 30, 2025. The goal was to identify changes in utilization trends after the practice adopted VBP reform, which took effect between July 1, 2015, through June 30, 2019. The primary outcomes were changed in the annual number of outpatient primary care visits and the number of behavioral health visits. The secondary outcomes were change in the annual number of mental health emergency department visits and hospitalizations.
The full text of āMedicaid Value-Based Payments and Health Care Use for Patients With Mental Illnessā was published September 22, 2023, by JAMA Health Forum. A free abstract is available online at https://jamanetwork.com/journals/jama-health-forum/fullarticle/2809746 (accessed October 19, 2023).
For more information, contact: Ashley Lewis, BS, Ph.D. Candidate, Department of Population Health, New York University Grossman School of Medicine, 227 East 30th Street, New York, New York 10016; Email: ashley.lewis@nyulangone.org; Website: https://med.nyu.edu/