Project Grant K01MH137322

ACCESS TO MENTAL HEALTH CARE SPECIALISTS IN MEDICARE ADVANTAGE: IMPROVING OUTCOMES FOR OLDER ADULTS - PROJECT SUMMARY CANDIDATE: MARK K. MEISELBACH IS AN EARLY CAREER HEALTH ECONOMIST AND HEALTH SERVICES RESEARCHER. HIS LONG- TERM CAREER GOAL IS TO BECOME A LEADING MENTAL HEALTH SERVICES RESEARCHER WHOSE RESEARCH INFORMS POLICIES TO IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH TREATMENT FOR UNDERSERVED POPULATIONS. RESEARCH CONTEXT: THERE IS A GROWING MENTAL HEALTH CRISIS AMONG OLDER ADULTS, BUT MOST OLDER ADULTS WITH MENTAL ILLNESS DO NOT RECEIVE TREATMENT. THIS MAY BE EXACERBATED BY THE RAPID GROWTH OF MEDICARE ADVANTAGE (MA), WHICH NOW ENROLLS MOST MEDICARE BENEFICIARIES, AS DR. MEISELBACH'S RECENT WORK SHOWS THAT FEW PSYCHIATRISTS ACCEPT MA PLANS COMPARED TO TRADITIONAL MEDICARE OR OTHER FORMS OF INSURANCE. THERE IS A CRITICAL NEED TO UNDERSTAND ACCESS TO MENTAL HEALTH SPECIALISTS IN MA AND HOW NETWORKS FOR MENTAL HEALTH SPECIALISTS IN MA IMPACT MENTAL HEALTH CARE AND OUTCOMES FOR OLDER ADULTS. SPECIFIC AIMS: USING MEDICARE CLAIMS DATA WITH NOVEL DATA LINKAGES, WE WILL 1) CHARACTERIZE VARIATION IN GEOGRAPHIC ACCESS TO MENTAL HEALTH SPECIALISTS FOR OLDER ADULTS; 2) EVALUATE THE IMPACT OF ACCESS TO IN-NETWORK MENTAL HEALTH SPECIALISTS IN MA ON UTILIZATION OF MENTAL HEALTH CARE AND CLINICAL OUTCOMES AMONG OLDER ADULTS IN MA; AND 3) INVESTIGATE PATIENT- AND PROVIDER-LEVEL FACTORS THAT MODIFY THE IMPACT OF ACCESS TO IN-NETWORK MENTAL HEALTH SPECIALISTS ON UTILIZATION OF MENTAL HEALTH CARE AND CLINICAL OUTCOMES. CAREER DEVELOPMENT PLAN: DR. MEISELBACH HAS A STRONG FOUNDATION IN HEALTH POLICY, ECONOMICS, AND ECONOMETRICS AND SUBSTANTIAL EXPERIENCE WORKING WITH ADMINISTRATIVE CLAIMS DATA AND OTHER LARGE DATABASES. TO ACHIEVE HIS LONG-TERM CAREER GOALS, HOWEVER, HE NEEDS TO BOLSTER HIS SKILLSET TO BETTER UNDERSTAND HOW THE QUANTITATIVE FINDINGS OF HIS RESEARCH RELATE TO THE EXPERIENCE OF PATIENTS AND CLINICIANS AND HOW TO TRANSLATE THESE FINDINGS TO MEANINGFUL POLICY CHANGE. THROUGH THIS K01 CAREER DEVELOPMENT AWARD, HE WILL RECEIVE TRAINING TO 1) ENHANCE HIS CLINICAL UNDERSTANDING OF MENTAL HEALTH TREATMENT IN OLDER ADULTS, 2) GAIN EXPERTISE IN GEOSPATIAL MEASUREMENT AND MODELING, 3) BECOME EXPERT IN CAUSAL INFERENCE IN MENTAL HEALTH RESEARCH, AND 4) DEVELOP INDEPENDENCE AND LEADERSHIP SKILLS TO INFORM POLICIES THAT IMPROVE ACCESS TO MENTAL HEALTH CARE. DR. MEISELBACH'S MENTORSHIP TEAM INCLUDES EXPERTS IN MENTAL HEALTH SERVICES RESEARCH, GERIATRICS AND GERIATRIC PSYCHIATRY, SPATIAL STATISTICS, CAUSAL INFERENCE, ECONOMICS, AND POLICY DISSEMINATION. RESEARCH GOALS: THE GOAL OF THIS RESEARCH IS TO EVALUATE THE IMPACT OF ACCESS TO MENTAL HEALTH SPECIALISTS ON OLDER ADULTS AND IDENTIFY THE GEOGRAPHIC AREAS AND FACTORS ASSOCIATED WITH WORSE ACCESS. PROVIDER NETWORKS IN MA ARE A MUTABLE POLICY TARGET. THESE FINDINGS CAN DIRECTLY INFORM POLICIES, SUCH AS NETWORK ADEQUACY REGULATION, TO IMPROVE ACCESS TO MENTAL HEALTH CARE AND OUTCOMES FOR OLDER ADULTS. THE PROPOSED STUDY IS CLOSELY ALIGNED WITH NIMH'S STRATEGIC GOAL 4 TO: ADVANCE MENTAL HEALTH SERVICES TO STRENGTHEN PUBLIC HEALTH, OBJECTIVE 4.1: IMPROVE THE EFFICIENCY, EFFECTIVENESS, AND REACH OF MENTAL HEALTH SERVICES THROUGH RESEARCH.