Medicaid Accountable Care Organizations (ACO) and Quality of Care for Adults with Serious Mental Illness (SMI)

医疗补助责任护理组织 (ACO) 和患有严重精神疾病的成人的护理质量 (SMI)

基本信息

批准号：
10351218
负责人：
Anna Goldman
金额：
$ 18.94万
依托单位：
BOSTON MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-14 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10351218
关键词：
Address Adult Affect Ambulatory Care American Benchmarking Caring Case Manager Cessation of life Characteristics Chronic Care Data Development Plans Drops Enrollment Evolution Funding General Population Goals Health Health Insurance Health Policy Health Services Accessibility Healthcare Homelessness Hospital Administrators Hospitals Incentives Individual Insurance Claim Review Interview Investigation Leadership Low income Massachusetts Measures Medicaid Medical Medicare Mental Health Methods Modeling National Institute of Mental Health Natural experiment Organizational Affiliation Organizational Models Outcome Patient Care Patients Perception Policies Population Proliferating Provider Quality Indicator Quality of Care Randomized Research Research Personnel Selection Bias Shapes Source Strategic Planning Structure System Time barrier to care care coordination career development comorbidity experience health care cost/financing health care delivery health care service organization hospital readmission improved insight parity participant enrollment patient population payment premature programs risk selection severe mental illness social social adversity social vulnerability tool

项目摘要

PROJECT SUMMARY Individuals with serious mental illness (SMI) are three times more likely to die prematurely than the general population. Sixty percent of this premature death is attributable to inadequate care of chronic, co-morbid medical conditions. A growing proportion of patients with SMI receive care in accountable care organizations (ACOs) – health care delivery and finance systems, in which global payments and quality benchmarks are used to incentivize quality care and lower spending. An increasing number of states are implementing ACO models in their Medicaid programs, the primary source of health insurance for low-income Americans with SMI. Medicaid ACOs exist in 12 states, caring for over 6% of the Medicaid population. Medicaid ACOs have the potential to both improve and worsen access to, and quality of, care for low-income adults with SMI. While financial structures that incentivize care coordination and programs that address health-related social needs likely benefit those with SMI, inadequate global payments that fail to account fully for social adversities such as homelessness could result in lower quality care. Certain features of Medicaid ACOs, e.g. leadership structure or ACO size, may amplify the benefits or drawbacks of the ACO model for patients with SMI. Evidence from Medicare ACOs has shown that smaller, provider-led ACOs and those serving a lower proportion of socially- vulnerable patients perform better in terms of quality. However, no evidence exists on how Medicaid ACO characteristics affect quality of care or the care experience of SMI adults. Since Medicaid ACOs are rapidly proliferating, filling this evidence gap is critical and can inform the evolution of the ACO model to better achieve the goal of mental health parity. In this K23 research plan, we propose to identify features of Medicaid ACOs (e.g. provider-led vs. hospital-led ACOs) that produce the highest quality ACO care for adults with SMI. We will undertake this research objective in three critical domains. First, we will study whether certain ACO types tend to drop patients with SMI, a practice known as favorable risk selection (or “cherry-picking”). This phenomenon can cause instability of ACO enrollment for patients, itself a marker of lower quality care. Second, we will compare care access and quality among adults receiving care in different ACO types. Lastly, we will use mixed methods to examine the care experiences of adults with SMI receiving care in different ACO types, through in-depth interviews and subsequent integration of qualitative and quantitative findings. For the first two aims, we will use Massachusetts All-Payer Claims Data and leverage the state’s unique auto- assignment mechanism as a natural experiment to study favorable risk selection, access, and quality. Auto- assignment refers to Medicaid randomly assigning individuals to ACOs, allowing us to compare outcomes across ACO types without selection bias caused by patients self-selecting their ACO affiliation. The goal of my K23 research is to guide policymakers and hospital administrators in shaping the Medicaid ACO model to produce more stable, higher-quality ACO care for patients with SMI.

项目概要患有严重精神疾病（SMI）的人过早死亡的可能性是一般人的三倍百分之六十的过早死亡归因于对慢性共病的护理不足。越来越多的 SMI 患者在责任医疗机构接受护理。 (ACO) – 医疗保健提供和金融系统，其中全球支付和质量基准越来越多的州正在实施 ACO。他们的医疗补助计划中的模型是患有 SMI 的低收入美国人的健康保险的主要来源。医疗补助 ACO 遍布 12 个州，照顾超过 6% 的医疗补助人口。可能会改善或恶化患有 SMI 的低收入成年人获得护理的机会和质量。激励护理协调的财务结构和解决与健康相关的社会需求的计划可能使那些患有 SMI 的人受益，全球支付不足，未能充分考虑社会逆境，例如无家可归可能会导致医疗补助 ACO 的某些特征，例如领导结构。或 ACO 大小，可能会放大 ACO 模型对 SMI 患者的益处或缺点。医疗保险 ACO 表明，较小的、由医疗服务提供者主导的 ACO 以及为较低比例的社会群体提供服务的 ACO 弱势患者在质量方面表现更好，但没有证据表明医疗补助 ACO 的效果如何。由于医疗补助 ACO 的快速发展，这些特征会影响 SMI 成人的护理质量或护理体验。扩散，填补这一证据空白至关重要，可以为 ACO 模型的演变提供信息，以更好地实现心理健康平等的目标在这个 K23 研究计划中，我们建议确定医疗补助 ACO 的特征。（例如提供者主导的 ACO 与医院主导的 ACO），为患有 SMI 的成人提供最高质量的 ACO 护理。我们将在三个关键领域开展这一研究目标，首先，我们将研究某些 ACO 类型是否存在。倾向于放弃 SMI 患者，这种做法被称为有利风险选择（或“择优选择”）。这种现象可能会导致 ACO 患者入组不稳定，这本身就是护理质量较低的标志。其次，我们将比较不同 ACO 类型中接受护理的成年人的护理获取和质量。我们将使用混合方法来检查在不同 ACO 接受护理的 SMI 成人的护理经历通过深入访谈以及随后整合定性和定量调查结果来确定类型。前两个目标，我们将使用马萨诸塞州所有付款人索赔数据并利用该州独特的自动分配机制作为研究有利的风险选择、访问和质量的自然实验。分配是指 Medicaid 将个人随机分配到 ACO，使我们能够比较结果跨 ACO 类型，不存在因患者自行选择 ACO 隶属关系而导致的选择偏差，这是我的目标。 K23 研究旨在指导政策制定者和医院管理者制定医疗补助 ACO 模型，以为 SMI 患者提供更稳定、更高质量的 ACO 护理。