Effects of Medicaid Coverage and State-Level Delivery Approaches on Healthcare Quality, Outcomes, and Costs for Adults with Diabetes

医疗补助覆盖范围和州级交付方法对成人糖尿病患者的医疗质量、结果和成本的影响

• 批准号: 10097549
• 负责人: Ronald T. Ackermann
• 金额: $ 44.62万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10097549
• 关键词: Effects; Medicaid; Coverage; State; Level

Project Summary Despite tremendous advances in diabetes, many Americans continue to have poor control over risk factors such as blood glucose, blood pressure, and cholesterol. As a result, diabetes continues to be a leading cause of death and many preventable complications, such as heart disease, stroke, chronic kidney disease, visual loss, and amputation. Many adults with diabetes still lack access to a coordinated healthcare team and do not complete evidence-based preventive services, receive medications or technologies that may improve disease care, participate in self-management behaviors, or follow-up for early detection and treatment of comorbidities and complications. This gap between evidence and practice disproportionately impacts the aged, those with disabilities, and the poor. As the primary health insurer for these vulnerable groups, Medicaid policies that expand eligibility requirements or lower barriers for initiating high value medications have the potential to improve healthcare engagement, delivery, and outcomes. States have a great deal of flexibility in administering Medicaid programs, and the Affordable Care Act and other health reforms further catalyzed state-level variation in eligibility, coverage, population management services, and financing. This variation presents a tremendous opportunity for natural experiments to evaluate the comparative effectiveness and costs of policy shifts on the care and outcomes of diabetes in vulnerable groups for whom the burden of diabetes is highest. We propose a Natural Experimental Research Center that will evaluate: 1) health and economic effects of state-specific variation in Medicaid managed care approaches for pharmacy utilization management affecting a newer class of diabetes medications with high costs but unique benefits: SGLT2 inhibitors; and 2) the medium- to longer-term effects of ACA expansion of health insurance coverage for adults with diabetes. We will leverage our access to two unique longitudinal datasets: (i) national claims data from UnitedHealth Group, a major Medicaid managed care provider for 6 million people in 27 states; and (ii) multi-state (Illinois, Indiana, Wisconsin) electronic heath records linked to Medicaid and Medicare claims. Outcomes of interest will include medication adherence, diabetes care quality, cardiometabolic risk factor control, acute diabetes complications, other forms of healthcare utilization, and costs. To evaluate state policies for medication utilization management, we will use difference-in-differences designs involving matched comparators in states with different policies. We will use the linked EHR-claims data from three states in novel, hybrid regression discontinuity (RD) and DiD designs to study the longer-term effects of ACA insurance expansion. Through direct engagement of collaborators and data contributors in participating states, our studies have been designed around high priority questions involving the effectiveness of particular programs. These studies are of high interest to state Medicaid programs and their managed care partners in all states, and our results will be communicated to them to guide policy decisions and to facilitate new natural experiments in the future.

项目摘要 尽管糖尿病取得了巨大进展，但许多美国人仍然对危险因素的控制权仍然很差 例如血糖，血压和胆固醇。结果，糖尿病仍然是主要原因 死亡和许多可预防的并发症，例如心脏病，中风，慢性肾脏疾病，视觉 损失和截肢。许多患有糖尿病的成年人仍然无法获得协调的医疗团队，而不会 完整的基于证据的预防服务，接受可能改善疾病的药物或技术 护理，参与自我管理行为或进行早期检测和治疗的随访 和并发症。证据与实践之间的差距不成比例地影响年龄的人， 残疾和穷人。作为这些弱势群体的主要健康保险公司，医疗补助保单 扩大资格要求或较低的障碍以启动高价值药物有可能 改善医疗保健参与，分娩和结果。各州在管理方面具有很大的灵活性 医疗补助计划以及《平价医疗法案》和其他健康改革进一步催化了州级 资格，承保范围，人口管理服务和融资的变化。这种变化呈现 自然实验的巨大机会来评估政策的比较效率和成本 糖尿病负担最高的弱势群体中糖尿病的护理和结局的转变。 我们提出了一个自然实验研究中心，该中心将评估：1） 医疗补助托管护理方法的药房利用率管理中的州特定差异影响了 较新的糖尿病药物具有高成本但独特的好处：SGLT2抑制剂； 2） 为成年人糖尿病的ACA扩展健康保险覆盖范围的长期影响。我们将 利用我们访问两个独特的纵向数据集的访问：（i）UnitedHealth Group的国家索赔数据，一个 在27个州，有600万人的主要医疗补助托管服务提供商； （ii）多州（伊利诺伊州，印第安纳州， 威斯康星州）与医疗补助和医疗保险索赔相关的电子荒地记录。感兴趣的结果将包括 药物依从性，糖尿病护理质量，心脏代谢风险因素控制，急性糖尿病并发症， 其他形式的医疗保健利用和成本。评估用药利用的国家政策 管理层，我们将使用涉及的状态中的匹配比较器的差异差异设计 不同的政策。我们将在新颖的混合回归中使用来自三个州的链接的EHR-EHR求主数据 不连续性（RD）并进行了设计以研究ACA保险扩展的长期影响。 通过直接参与合作者和参与州的数据贡献者，我们的研究已经 围绕涉及特定计划有效性的高优先级问题设计。这些研究 州医疗补助计划及其在所有州的托管护理伙伴都非常感兴趣，我们的结果 将向他们传达以指导政策决策并促进将来的新自然实验。