The Effects of Statewide Comprehensive Integrated Care for Medicaid Enrollees.

全州范围内综合综合护理对医疗补助参与者的影响。

• 批准号: 10404642
• 负责人: Kenneth John McConnell
• 金额: $ 68.84万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10404642
• 关键词: Address; Adoption; Adult; Affect; Bipolar Disorder; Caring; Child; Client; Clinical; Communication; Contracts; County; Criminal Justice; Data; Database Management Systems; Effectiveness; Employment; Environment; Funding; General Population; Health Benefit; Health Expenditures; Health system; Healthcare; Healthcare Systems; Housing; Improve Access; Individual; Interview; Knowledge; Link; Major Depressive Disorder; Managed Care; Managed Care Programs; Measures; Medicaid; Mental Health; Mental Health Services; Mental disorders; Modeling; National Institute of Mental Health; Natural experiment; Outcome; Patient-Focused Outcomes; Patients; Persons; Policies; Population; Primary Health Care; Privatization; Public Health; Qualitative Methods; Research; Research Design; Resources; Risk; Schizophrenia; Services; Social Work; Specialist; Specific qualifier value; Structure; System; Testing; Time; Vital Statistics; Washington; Work; beneficiary; design; flexibility; housing instability; improved; improved outcome; insight; medical specialties; payment; physical conditioning; physical health service; programs; provider networks; public health insurance; randomized trial; response; severe mental illness; social health determinants

PROJECT SUMMARY The design of public insurance in providing mental health services is a critically important policy issue. A large number of studies have demonstrated substantial benefits for patients in integrated care models, which allow access to primary physical and mental health care in one setting. However, widespread adoption of integrated care models has not occurred. A critical and continuing barrier is the separation of financing and payment for physical and mental health services, particularly in the form of mental health “carve-outs” in Medicaid programs. Carve-outs are perceived to create barriers and hamper the aspirational potential of integrated care. To understand the potential for states to widely disseminate integrated care, we propose to study Washington State’s “Integrated Managed Care” (IMC) initiative. Under this initiative, Medicaid beneficiaries will receive comprehensive physical and mental health services through a single, integrated managed care plan. The implementation of IMC takes place in a staggered fashion over the 2016-2020 timespan, with counties assigned to one of five waves that must transition from the existing carve-out system to IMC. This natural experiment creates an opportunity for a robust quantitative and qualitative study of the effects of full (financial and service) integration of physical and mental health. Our proposal leverages Washington’s Integrated Client Database System, a unique resource linking Medicaid claims to rich measures of social determinants of health, including housing, employment, and contacts with the criminal justice system. The proposed research seeks to enhance our understanding of how states can advance the use of integrated care, including the factors that may facilitate or hinder integration, and whether full financial integration can affect resource use or impact social determinants of health. We seek to fill these gaps in knowledge with the hope of providing actionable information to Medicaid agencies and health systems across the U.S., addressing questions about the feasibility and benefits of financial integration, with specific information about carving in or carving out services, the factors that facilitate integration at the clinical level, and the ways in which social service needs among individuals with severe mental illness are affected. This work is closely aligned with NIMH’s Strategic Objective 4.1 to “improve the efficiency and effectiveness of existing mental health services,” which includes research to “optimize financing models for adults and children with serious mental illnesses to provide efficient and effective care in public and private health care systems.” The combination of a strong natural experiment, detailed contextual data, and a rich set of outcomes will allow us to develop rigorous and actionable evidence to guide the provision of mental health services in Medicaid.

项目摘要 在提供心理健康服务方面的公共保险设计是至关重要的政策问题。一个大 研究的数量表明，在综合护理模型中为患者带来了可观的好处，这允许 在某种程度上获得初级身体和心理保健。但是，采用集成的宽度 护理模型尚未发生。关键且持续的障碍是分离融资和付款 身心健康服务，尤其是在医疗补助的心理健康“雕刻”的形式 程序。人们认为，雕刻出来会造成障碍，并妨碍综合护理的理想潜力。 为了了解各州广泛传播综合护理的潜力，我们建议研究华盛顿 州的“综合托管护理”（IMC）倡议。根据这项倡议，医疗补助受益人将获得 通过单个综合托管护理计划进行全面的身心健康服务。 IMC的实施是在2016 - 2020年的时间潘上以交错的方式进行的 分配给必须从现有的雕出系统过渡到IMC的五波之一。这个自然 实验为对全面影响进行了强大的定量和定性研究创造了机会（财务 和服务）整合身心健康。我们的建议利用华盛顿的综合客户 数据库系统是一种独特的资源，将医疗补助索赔与健康决定者的丰富措施联系在一起， 包括住房，就业和与刑事司法系统的联系。 拟议的研究旨在增进我们对国家如何推动综合使用的理解 护理，包括可能有助于或阻碍整合的因素，以及完全的财务整合是否可以 影响资源使用或影响健康的社会决定者。我们试图通过 希望向美国各地的医疗补助机构和卫生系统提供可行的信息，以解决 有关财务整合的可行性和利益的问题，以及有关在或 雕刻服务，促进临床层面整合的因素以及社会方式的方式 患有严重精神疾病的人的服务需求受到影响。这项工作与 NIMH的战略目标4.1“提高现有心理健康服务的效率和有效性”， 其中包括“为成人和患有严重精神疾病的儿童优化融资模型的研究 在公共和私人保健系统中提供有效的护理。” 自然实验，详细的上下文数据以及丰富的结果集将使我们能够发展严格和 可行的证据指导在医疗补助中提供心理健康服务。