Alcohol treatment in Medicaid managed care plans: Disparities in policies and outcomes

医疗补助管理式医疗计划中的酒精治疗：政策和结果的差异

基本信息

批准号：
10491328
负责人：
Maureen T Stewart
金额：
$ 56.88万
依托单位：
BRANDEIS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-20 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10491328
关键词：
Address Administrator Alcohol consumption Alcohols American Area Behavior Therapy COVID-19 Caring Contracts Data Decision Making District of Columbia Emergency department visit Equilibrium Ethnic Origin Evidence based treatment FDA approved Gender Geography Goals Health Health Insurance Health Services Health Services Accessibility Hospitalization Improve Access Insurance Benefits Link Mainstreaming Managed Care Managed Care Programs Medicaid Medical Minority Women Morbidity - disease rate Organizational Policy Outcome Patients Pharmaceutical Preparations Pharmacotherapy Police Policies Policy Maker Population Race Regulation Reporting Rural Surveys Treatment Cost Treatment outcome United States Woman addiction alcohol abuse therapy alcohol availability alcohol misuse alcohol use disorder alcohol-related death barrier to care behavioral health binge drinking care outcomes cost design ethnic minority experience federal policy follow-up health care service health disparity health management health plan improved innovation mortality programs provider networks racial and ethnic racial difference racial minority response rural Americans rural area rural setting social health determinants social stigma success tool treatment services waiver

项目摘要

Rates of alcohol-related morbidity and mortality are disproportionately high and increasing among racial/ethnic minorities and women and in rural areas. Almost 90,000 Americans die annually from alcohol use. Despite the health consequences, fewer than 10% of those with alcohol use disorder (AUD) receive evidence-based treatment, and racial/ethnic minorities and women are less likely to access treatment. Barriers to treatment include stigma, treatment setting appeal, and health insurance benefit design. Medicaid programs are among the most important payers for AUD treatment and rates of AUD in the Medicaid population are especially high. Medicaid provides health insurance for more than 77 million Americans, including a large and disproportionate share of racial/ethnic minorities, women, and rural Americans. Almost all state Medicaid programs contract with Medicaid managed care organizations (MMCOs) to deliver and manage health care services and nearly 70% of Medicaid enrollees are now in managed care. MMCOs must adhere to state requirements and policies, but have considerable discretion over polices that may influence access, treatment appeal, and cost. However, there is almost no information or transparency on MMCO polices related to alcohol treatment services. This study systematically examines AUD treatment policies in MMCOs, an under-explored level where important decisions are made that influence access and outcomes. We will conduct a national survey of MMCOs and link their responses to patient-level Medicaid data. The specific aims are: 1) Examine Medicaid MMCO alcohol treatment policies (e.g. coverage, utilization management, provider networks, innovations) across MMCOs that contract with the 50 states and District of Columbia; determine whether there are differences in MMCO alcohol treatment policies by state Medicaid policies. 2) Assess the relationship between MMCO policies and access to AUD treatment (e.g. initiation and engagement in treatment, follow-up after hospitalization) by race/ethnicity, gender, and rural/urban geography. 3) Assess the relationship between MMCO policies and alcohol treatment outcomes (i.e.. treatment retention, pharmacotherapy duration, hospitalization, ED visit) by race/ethnicity, gender and rural/urban geography. Our interdisciplinary team is uniquely qualified with experience conducting four previous commercial health plan behavioral health studies, and conducting rigorous disparities and Medicaid analyses. Findings will provide valuable information on MMCO policies and their associations with access, treatment appeal and cost for racial/ethnic minorities and other Americans. This information can be used by plan administrators as they develop and implement policies, state Medicaid directors as they contract with and regulate MMCOs, and federal policy makers making determinations about Medicaid waivers and other efforts to improve access to alcohol treatment in the US.

与酒精相关的发病率和死亡率的率不成比例高，种族/族裔的增长速度增加少数民族和妇女以及农村地区。每年有近90,000名美国人死于饮酒。尽管有健康后果，饮酒障碍（AUD）的人中不到10％接受循证治疗，种族/族裔少数民族和妇女不太可能获得治疗。治疗的障碍包括污名，治疗设置上诉和健康保险福利设计。医疗补助计划是在医疗补助人群中，最重要的AUD治疗付款人和AUD率特别高。 Medicaid为超过7700万美国人提供健康保险，包括大型且不成比例的种族/族裔少数民族，妇女和乡村美国人的份额。几乎所有州医疗补助计划都与医疗补助管理组织（MMCO）提供和管理医疗服务，近70％现在的医疗补助招待会正在托管护理中。 MMCO必须遵守州要求和政策，但对可能影响访问，治疗上诉和成本的政策有相当大的酌处权。然而，几乎没有关于与酒精治疗服务有关的MMCO政策的信息或透明度。这研究系统地检查了MMCO中的AUD治疗政策，这是一个不足的水平做出了影响访问和结果的决定。我们将对MMCO进行全国调查并链接他们对患者级医疗补助数据的反应。具体目的是：1）检查医疗补助MMCO酒精跨MMCO的治疗政策（例如覆盖范围，利用管理，提供商网络，创新）与50个州和哥伦比亚特区的签约；确定MMCO酒精是否存在差异国家医疗补助政策的治疗政策。 2）评估MMCO政策与访问权限之间的关系 AUD治疗（例如，启动和参与治疗，住院后的随访），种族/民族，性别和农村/城市地理。 3）评估MMCO政策与酒精处理之间的关系结局（即保留治疗保留，药物治疗持续时间，住院，ED参观），种族/民族，性别与农村/城市地理。我们的跨学科团队具有独特的资格以前的四个商业健康计划行为健康研究，并进行严格的差异和医疗补助分析。调查结果将提供有关MMCO政策及其关联的宝贵信息种族/族裔少数民族和其他美国人的访问，治疗上诉和成本。此信息可以是计划管理员在制定和执行政策时使用的是医疗补助董事与MMCO和联邦政策制定者一起确定医疗补助豁免和其他政策制定者在美国改善酒精治疗的努力。