Examining opioid use disorder treatment in Medicaid managed care plans: policies and outcomes

检查医疗补助管理式医疗计划中的阿片类药物使用障碍治疗：政策和结果

• 批准号: 10212998
• 负责人: Maureen T Stewart
• 金额: $ 69.85万
• 依托单位: BRANDEIS 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 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10212998
• 关键词: Address; Administrator; Adopted; Affect; Affordable Care Act; Area; Buprenorphine; Caring; Characteristics; Complex; Contracts; Data; District of Columbia; Effectiveness; Evidence based treatment; FDA approved; Federal Government; Fee-for-Service Plans; Funding; General Population; Headache; Health Benefit; Health Insurance; Health Services; Health Services Accessibility; Individual; Knowledge; Link; Managed Care Programs; Medicaid; Mental Health; Methadone; Naltrexone; National Institute of Drug Abuse; National Institute on Alcohol Abuse and Alcoholism; Opiate Addiction; Opioid; Outcome; Overdose; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacotherapy; Police; Policies; Policy Maker; Population; Privatization; Provider; Research; Services; State Government; Substance Use Disorder; Surveys; Time; United States; Variant; addiction; behavioral health; care outcomes; density; design; federal policy; flexibility; health care service; health management; health plan; innovation; opioid epidemic; opioid misuse; opioid use disorder; parity; payment; physical health service; prior authorization; programs; response; social stigma; stem; treatment services; waiver; willingness

The United States continues to struggle with a major opioid crisis. This is a critical issue for state Medicaid programs as rates of opioid use disorders (OUD) in the Medicaid population are almost twice as high as the general population. Nearly 40% of people with OUD have Medicaid. Evidence-based treatments for OUD, including the three FDA-approved medications, exist but are underutilized. Barriers to access and retention in treatment are numerous and complex, including stigma, provider capacity and health insurance policies. Federal and state governments regulate Medicaid Health Plans (MHPs); however the plans have discretion in several areas including coverage, utilization management, network management, provider payment and innovative policies. Plan policies directly affect individual access both through coverage and through provider willingness to offer services, given lack of coverage, administrative headaches from utilization management requirements and low payment rates. Despite the opioid crisis, there is almost no information or transparency on MHP polices related to opioid treatment services. The proposed study aims to systematically examine delivery and management of OUD treatment in MHPs, an under-explored level where important decisions are made. We will conduct a national survey of MHPs and link their responses to national data on health plan quality and to patient-level Medicaid data from three states in order to examine outcomes. The specific aims are: Aim 1. Describe Medicaid health plan OUD treatment policies (e.g. coverage requirements, utilization management, network design, payment, and innovative care approaches) across MHPs that contract with 50 states and the District of Columbia and identify state policies, market and plan characteristics associated with OUD treatment policies. Aim 2. Evaluate the relationship between Medicaid health plans’ OUD treatment policies and plan-level rates of enrollee access to and quality of OUD treatment. Aim 3. Evaluate the relationship between Medicaid health plans’ OUD treatment policies and patient-level outcomes of OUD treatment (e.g. pharmacotherapy duration, overdose). The study team is uniquely qualified for this project and will leverage expertise developed in four previous NIDA and NIAAA-funded commercial health plan surveys of delivery and management of behavioral health services and 2 previous NIDA-funded Medicaid studies. Findings will provide valuable information regarding access to and effectiveness of OUD treatment under Medicaid plans. This information can be used by plan administrators as they develop and implement plan policies, state Medicaid directors as they contract with and regulate MHPs and federal policy makers making determinations about use of Medicaid waivers and other efforts to address OUD in the US, to help stem the tide of OUD and its often-deadly consequences.

美国仍在与严重的阿片类药物危机作斗争，这对国家医疗补助来说是一个关键问题。 因为医疗补助人群中阿片类药物使用障碍 (OUD) 的比例几乎是普通人群的两倍 近 40% 的 OUD 患者接受基于证据的 OUD 治疗。 包括 FDA 批准的三种药物，存在但未得到充分利用。 治疗方法众多且复杂，包括耻辱、提供者能力和健康保险政策。 联邦和州政府监管医疗补助健康计划 (MHP)，但该计划拥有酌处权； 多个领域，包括覆盖范围、使用管理、网络管理、提供商支付和 创新政策通过覆盖范围和提供者直接影响个人的获取。 鉴于缺乏覆盖范围、利用管理带来的行政难题，愿意提供服务 尽管存在阿片类药物危机，但几乎没有信息或透明度。 与阿片类药物治疗服务相关的 MHP 政策。 拟议的研究旨在系统地检查 MHP 中 OUD 治疗的实施和管理，这是一种 我们将对 MHP 进行全国调查并建立联系。 他们对国家健康计划质量数据和来自三个州的患者医疗补助数据的回应 为了检查结果。 目标 1. 描述 Medicaid 健康计划 OUD 治疗政策（例如承保范围要求、利用率 管理、网络设计、支付和创新护理方法） 50 个州和哥伦比亚特区，并确定相关的州政策、市场和计划特征 与 OUD 处理政策。 目标 2. 评估医疗补助健康计划的 OUD 治疗政策与计划级别之间的关系 参与者获得 OUD 治疗的比率和质量。 目标 3. 评估医疗补助健康计划的 OUD 治疗政策与患者水平之间的关系 OUD 治疗的结果（例如药物治疗持续时间、药物过量）。 该研究团队具有该项目的独特资格，并将利用之前四个项目中开发的专业知识 NIDA 和 NIAAA 资助的商业健康计划调查行为健康的提供和管理 服务和 NIDA 资助的 2 项医疗补助研究结果将提供有关的宝贵信息。 根据 Medicaid 计划获得 OUD 治疗的机会和有效性 该信息可由计划使用。 管理者在制定和实施计划政策时，州医疗补助董事在与他们签订合同时 规范 MHP 和联邦政策制定者就医疗补助豁免和其他规定的使用作出决定 努力解决美国的 OUD 问题，帮助遏制 OUD 浪潮及其往往致命的后果。