Alternative payment models and alcohol use disorder treatment and consequences

替代支付模式和酒精使用障碍治疗及后果

• 批准号: 10642757
• 负责人: Susan H Busch
• 金额: $ 57.8万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10642757
• 关键词: Acute; Adult; Award; Black race; COVID-19; Caring; Certification; Chronic; Clinic; Clinical; Communities; Complex; Cost Savings; County; Crime; Data; Evidence based treatment; Grant; Health; Health Services; Health system; Hispanic; Improve Access; Incentives; Individual; Information Systems; Infrastructure; Interdisciplinary Health Team; Investments; Low income; Medicaid; Medical; Mental Health; Methodology; Modeling; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Performance; Physicians; Policies; Primary Care; Prospective Payment System; Provider; Public Health; Quasi-experiment; Recovery; Reimbursement Mechanisms; Reporting; Research; Research Personnel; Resources; Savings; Services; Substance Use Disorder; Surgeon; System; Telemedicine; Traffic accidents; Training; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; addiction; alcohol involvement; alcohol use disorder; behavioral health; black patient; cost; design; evidence base; flexibility; health disparity populations; improved; information technology workforce; interest; intimate partner violence; medical specialties; neighborhood disadvantage; pandemic disease; payment; policy implication; preventable death; programs; public health emergency; screening; service delivery; societal costs; treatment and outcome; treatment services; vehicular accident

PROJECT SUMMARY Alcohol Use Disorder (AUD) is one of the leading causes of preventable death in the US and has high personal and societal costs. Despite the widespread acceptance that evidence-based treatments exist for AUD, less than one in nine individuals with AUD report receiving specialty treatment. Challenges are particularly acute in disadvantaged communities. Only 60 percent of US counties have a specialty substance use disorder (SUD) treatment clinic that accepts Medicaid, despite Medicaid being the largest payer of addiction treatment services in the US. In 2017, The Centers for Medicare and Medicaid Services initiated the Certified Community Behavioral Health Clinic (CCBHC) demonstration, a program designed to increase access and the receipt of evidence-based care in Medicaid in eight states. As a part of this initiative, CCBHCs were required to provide nine services chosen to improve access; to provide data on quality metrics; and to engage in a prospective payment system. Since the initial 66-clinic demonstration, the CCBHC program has expanded to over 240 clinics in 40 states; A primary distinction between the initial demonstration and the expanded model is that in the expanded model clinics retain traditional reimbursement mechanisms but are awarded a large annual grant (~$2 million). We use a quasi-experimental approach to compare changes in the receipt of AUD services before and after CCBHC program implementation with changes in the receipt of AUD services in a set of matched comparison clinics (or counties). Our project brings together an interdisciplinary team of health services researchers, physicians, and economists with the methodological and substantive expertise to examine this understudied issue and explore its complex public health, clinical, and policy implications. Our specific aims are to assess whether CCBHC implementation was associated with: 1a) Changes in AUD identification and treatment quality; 1b) Differential changes in AUD identification and treatment quality in demonstration versus expansion clinics; 2) Differential changes in AUD treatment receipt and quality during the COVID-19 public health emergency in CCBHC compared to non-CCBHC clinics; and 3) Changes in trajectories of public health outcomes, including county-level reports of crime and alcohol-involved fatal motor vehicle accidents. This grant is responsive to NOT-AA-20-022, “Notice of Special Interest: Advances in Research for the Treatment, Services, and Recovery of Alcohol Use Disorder” and will provide information ‘to bridge the gap between those who need treatment and those who receive treatment.’ In addition, we focus on the Medicaid program, which disproportionately serves NIH-designated US health disparity populations. The significance of this study lies in its focus on how to optimize delivery systems to improve treatment and outcomes associated with AUD, a growing challenge and understudied policy issue.

项目摘要 酒精使用障碍（AUD）是美国可预防死亡的主要原因之一，并且具有很高的个人化原因 和社会成本。尽管接受了AUD存在基于证据的治疗的广泛接受，但更少 超过九分之一的AUD报告接受专业治疗的人。挑战特别严重 处境不利的社区。美国只有60％的县患有特殊药物使用障碍（SUD） 接受医疗补助的治疗诊所，Mission Medicaid是成瘾治疗服务的最大付款人 在美国。 2017年，医疗保险和医疗补助服务中心启动了认证社区 行为健康诊所（CCBHC）演示，该计划旨在增加访问和接收 八个州的医疗补助循证护理。作为该计划的一部分，要求CCBHC提供 九项服务选择改善访问权限；提供有关质量指标的数据；并参与潜在的 付款系统。自最初的66个临床演示以来，CCBHC计划已扩展到240多个 40个州的诊所；初始演示和扩展模型之间的主要区别是 扩展的模型诊所保留了传统的报销机制，但被授予了大型年度赠款 （约200万美元）。我们使用准实验方法比较接收AUD服务的变化 CCBHC计划实施之前和之后，随着一组AUD服务的更改 匹配的比较诊所（或县）。我们的项目汇集了一个跨学科的健康团队 为研究人员，医师和经济学提供服务学和实质专家的服务 检查这个理解的问题，并探索其复杂的公共卫生，临床和政策影响。我们的 具体目的是评估CCBHC实施是否与：1A）AUD更改 识别和治疗质量； 1b）AUD识别和治疗质量的差异变化 演示与扩张诊所； 2）AUD处理收据和质量的差异变化 与非CCBHC诊所相比，CCBHC的COVID-19-COVID-19公共卫生紧急情况； 3）变化 公共卫生成果的轨迹，包括县级犯罪和涉及酒精的致命运动的报告 车祸。这笔赠款对非AA-20-022的反应，“特别关注通知：进步 研究酒精使用障碍的治疗，服务和恢复”将提供 信息“弥合需要治疗的人与接受治疗的人之间的差距。” 此外，我们专注于医疗补助计划，该计划不成比例地为NIH指定的美国健康服务 差异人群。这项研究的意义在于它的重点是如何优化交付系统 改善与AUD相关的治疗和结果，这是日益增长的挑战和理解的政策问题。