Disparities in Access to Serious Mental Illness Care Following the Implementation of Value-Based Payment Reform in the Oregon Medicaid Program

Racial and ethnic disparities in mental health care access are especially consequential for the health outcomes of Medicaid beneficiaries living with serious mental illness (SMI). This descriptive study of Oregon Medicaid claims data assessed for disparities in access to SMI care for Oregon's adult Medicaid beneficiaries from 2010 to 2019, examining changes following the implementation of value-based payment (VBP) in 2012. Multivariable regression analyses compared changes in access to SMI care, pre- and post-VBP implementation, by race and ethnicity. Relative to White beneficiaries, VBP implementation was associated with net increases of 0.28% (95% confidence interval [CI]: [0.01%, 0.55%]) in the rate of access among Black beneficiaries (a complete reduction of the pre-VBP disparity) and 0.34% (95% CI: [0.17%, 0.51%]) among Latinx beneficiaries (narrowing but not closing the pre-VBP disparity). The Oregon policy's focus on access, equity, and beneficiaries with mental illness might have contributed to the observed reductions in disparities.