MANAGED CARE FOR ALCOHOL DISORDERS IN MICHIGAN

密歇根州酒精障碍的管理护理

• 批准号: 6163742
• 负责人: Donald Sloane Shepard
• 金额: $ 16.75万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-03-01 至 2002-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6163742
• 关键词: Medicare /Medicaid; alcoholism /alcohol abuse therapy; behavioral /social science research tag; clinical research; female; gender difference; health care cost /financing; health care model; health care service evaluation; health care service organization; health care service utilization; human data; managed care; outcomes research; patient care management; primary care physician; racial /ethnic difference

This research aims to evaluate different approaches to the organization of care for alcohol disorders, and compare their impact on patterns of cost, utilization and outcomes. We will study how utilization, costs and outcomes of alcohol treatment are affected by two managed care programs: the primary care case manager (PCCM) model, and the capitated specialty vendor model ('carve-out'). The two models differ in the way that they link behavioral health care to medical care, and in the degree of control exercised by the gatekeeper. We expect these design differences to result in different impacts on treatment patterns. The study has three specific aims: 1. Describe and evaluate how service utilization and costs of care for alcohol disorders are affected by managed care, and by the extent to which managed care for alcohol problems is integrated with managed care of other problems. 2. Examine how outcomes for alcohol-disorder patients are affected by managed care, and by the extent to which managed care for alcohol problems is integrated with managed care of other problems. 3. Evaluate whether managed care impacts on cost and utilization differ for women and people of color. To address these aims, we analyze Medicaid data from two states which have implemented the two managed care models in question. Both Massachusetts and Michigan recently made managed care enrollment mandatory for most Medicaid recipients, requiring them to join either PCCMs or capitated plans such as HMOs. However, Massachusetts also 'carved out' the behavioral health services, to be managed by a capitated specialty vendor. By contrast, Michigan did not separate behavioral health from other care, thereby leaving it to be managed by PCCMs. For each of these states, we will collect and analyze claims data for two years before and three years after the start of the managed care intervention. The results will provide insight about the role of organizational arrangements in determining the patterns of treatment for alcohol disorders.

本研究旨在评估不同的组织方法 护理酒精障碍，并比较其对成本模式的影响， 利用率和结果。我们将研究利用率、成本和 酒精治疗的结果受到两个管理式医疗计划的影响： 初级保健病例经理 (PCCM) 模式和按人头专科 供应商模式（“剥离”）。这两个模型的不同之处在于它们的方式 将行为保健与医疗保健以及控制程度联系起来 由看门人行使。我们预计这些设计差异会产生 对治疗模式的不同影响。 该研究有三个具体目标： 1. 描述并评估服务利用和护理成本如何 酒精障碍受到管理式医疗的影响，并且受到管理式医疗的影响程度 针对酒精问题的管理式护理与其​​他问题的管理式护理相结合 问题。 2. 检查酒精障碍患者的结果如何受到影响 管理式护理，以及管理式护理对酒精问题的程度 与其他问题的管理式医疗相结合。 3. 评估管理式医疗对成本和利用率的影响是否不同 对于女性和有色人种。 为了实现这些目标，我们分析了两个州的医疗补助数据 实施了两种有问题的管理式医疗模式。两者都是马萨诸塞州 密歇根州最近强制要求大多数人参加管理式医疗登记 医疗补助接受者，要求他们加入 PCCM 或按人头 计划，例如 HMO。然而，马萨诸塞州也“开辟”了 行为健康服务，由按人头付费的专业供应商管理。 相比之下，密歇根州并没有将行为健康与其他护理分开， 从而将其交由 PCCM 管理。 对于每个州，我们将收集并分析两个州的索赔数据 管理式医疗开始前一年和三年后 干涉。结果将提供有关以下角色的见解： 确定治疗模式的组织安排 酒精障碍。