Background: The COVID pandemic has exposed multiple cracks in our healthcare system, and while the healthcare industry is grappling with its initial effects, there is an ever-increasing necessity to improve quality of patient care. States are attempting to identify how to maintain preventive service uptake, care continuity, and specialty care such as behavioral health. The Medicaid Medical Directors (MMDs) understand the value of and express a need for patient-centered outcomes research (PCOR) to inform key decisions, including those related to coverage and payment policies. Policy-relevant PCOR has proven useful to Medicaid clinical leaders focused on improving Medicaid program design, meeting individual health promotion and treatment needs of Medicaid beneficiaries, advancing population health at the community level, and reducing disparities.
Proposed Solution to the Problem: In order to address and prioritize PCOR research gaps to further understand COVID impacts, the project team proposes supporting and extending the work of the Medicaid Medical Directors Network (MMDN) to discuss and review select PCORI-funded studies on mental and behavioral health and consider research and translation gaps and dissemination avenues to promote evidence use and increase uptake.
Objectives: Convening these stakeholders will achieve two long-term objectives: to continue informing the ongoing development of PCORI research studies to ensure their relevance to Medicaid populations and stakeholders through peer engagement and review of PCOR-relevant research topics and questions; and to advance the use of PCOR evidence in Medicaid policy decision making and care delivery informed by implementation science frameworks.
Activities: AcademyHealth MMDN staff bring substantive expertise with utilizing implementation science frameworks and managing this and complementary learning networks (e.g., State-University Partnership Learning Network), and, having built strong relationships with the membership, will continue to facilitate a variety of programming activities for the MMDN including:
- Convening one structured multi-stakeholder virtual meeting (tentatively planned for June)
- Facilitating three listening sessions devoted to reviewing/prioritizing mental and behavioral health PCOR evidence, identifying dissemination strategies and barriers, and providing feedback on the Medicaid implementation roadmap
- Developing a Medicaid implementation roadmap that will identify a catalog of dissemination and implementation strategies for diverse Medicaid stakeholders
- Conducting bimonthly calls with steering committee to provide guidance in programming activities and deliverables (e.g., meeting agenda and presenters, listening session on Medicaid implementation roadmap)
Projected Outcomes and Outputs: Funding for this project will allow for diverse engagement beyond current peer-shared learning to focus on disseminating relevant and timely PCOR evidence that can improve healthcare policy and practice. This structured engagement can spur discussions about gaps in evidence translation and promote considerations for improved dissemination. This project will explore systematic approaches for translating and sharing relevant PCOR evidence that can aid MMDs and their MCO Medical Directors in implementing policies that improve healthcare practice and the health of Medicaid beneficiaries. The project’s implementation roadmap will be distributed through participants’ channels to further educate on and improve dissemination and implementation of PCOR evidence.
Patient and Stakeholder Engagement Plan: MMDs perform a strategic role in identifying and addressing the healthcare needs of beneficiaries (i.e., patients being served by the Medicaid program). They serve at the intersection of clinical practice, quality improvement, and business operations; they also play a critical role in the development and implementation of Medicaid healthcare policy for the states. Many MMDs continue to be actively engaged with their patients, patient families, and other stakeholders. Through their work with the Medicaid program, MMDs bridge policy and practice, offering direct insight into how policy affects patients/consumers. As such, through dissemination and implementation efforts, the MMDN and its clinician members have the ability to impact health outcomes at the ground level with patients and other related stakeholders. In addition, Medicaid managed care representatives provide additional coverage context for services across multiple settings and in alignment with recommended preventive services. They will play a significant role in determining if current research findings align with the type of care patients have at their disposal. These three stakeholder groups will formulate research questions, design strategies to increase the quality of behavioral health services, and disseminate the results within their state to affect and influence patient care.