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：
10629356
负责人：
Maureen T Stewart
金额：
$ 59.01万
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/10629356
关键词：
Address Administrator Alcohol consumption Alcohols American Area Behavior Therapy COVID-19 Caring Contracts Data Decision Making Disparity 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 Morbidity - disease rate Organizational Policy Outcome Patients Pharmaceutical Preparations Pharmacotherapy Police Policies Policy Maker Population Qualifying Race Regulation Reporting Rural Surveys Treatment Cost Treatment outcome United States Woman access disparities 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 outcome disparities programs provider networks 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不成比例地高，并且在不同种族/族裔中呈上升趋势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。尽管健康后果，只有不到 10% 的酒精使用障碍 (AUD) 患者接受基于证据的治疗少数种族/族裔和妇女获得治疗的可能性较小。治疗障碍包括耻辱感、治疗环境吸引力和健康保险福利设计。医疗补助计划是其中之一澳元治疗的最重要支付者，并且医疗补助人群中的澳元比率特别高。医疗补助计划为超过 7700 万美国人提供健康保险，其中包括大量不成比例的医疗保险少数种族/族裔、妇女和农村美国人的比例。几乎所有州医疗补助计划都与医疗补助管理式医疗组织 (MMCO) 提供和管理医疗保健服务，近 70% 的医疗补助参与者目前正在接受管理式医疗服务。 MMCO 必须遵守国家要求和政策，但是对可能影响可及性、治疗吸引力和费用的政策有相当大的自由裁量权。然而，与酒精治疗服务相关的 MMCO 政策几乎没有任何信息或透明度。这研究系统地考察了 MMCO 中的 AUD 治疗政策，这是一个尚未探索的水平，但很重要做出的决策会影响访问和结果。我们将对 MMCO 进行全国调查并链接他们对患者层面的医疗补助数据的反应。具体目标是： 1) 检查 Medicaid MMCO 酒精 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签订合同；判断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按种族/民族划分的 AUD 治疗（例如开始和参与治疗、住院后的随访），性别和农村/城市地理。 3）评估MMCO政策与酒精治疗之间的关系按种族/民族划分的结果（即治疗保留、药物治疗持续时间、住院、急诊就诊），性别和农村/城市地理。我们的跨学科团队拥有独特的资格，拥有丰富的经验之前的四项商业健康计划行为健康研究，并进行了严格的差异和医疗补助分析。调查结果将提供有关 MMCO 政策及其与少数种族/族裔和其他美国人的获取、治疗诉求和费用。该信息可以是计划管理者在制定和实施政策时使用，医疗补助董事在签订合同时使用与 MMCO 合作并对其进行监管，联邦政策制定者就医疗补助豁免和其他事项做出决定努力改善美国酒精治疗的可及性。