Medicaid Managed Care Coverage and Utilization Management of Opioid Use Disorder Treatment

阿片类药物使用障碍治疗的医疗补助管理式医疗覆盖范围和利用管理

基本信息

批准号：
10617393
负责人：
Christina Marie Andrews
金额：
$ 61.56万
依托单位：
UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
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：
2021-07-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10617393
关键词：
Address Adverse event Affect American Attention Awareness COVID-19 Caring Cessation of life Clinical Contracts Data Data Set Diagnosis Drops Emergency department visit Ensure Epidemic FDA approved Fee-for-Service Plans Health Health Services Accessibility Hospitalization Improve Access Insurance Carriers Investigation Kentucky Link Managed Care Medicaid Medical Methods Monitor New York Ohio Opioid Outcome Overdose Patients Pharmaceutical Preparations Policies Policy Maker Population Positioning Attribute Prevalence Public Health Randomized Recommendation Recording of previous events Regulation Research Risk Reduction Selection Bias Series Specific qualifier value Structure Substance Use Disorder Time Virginia Vulnerable Populations access restrictions acute care adverse outcome design evidence base falls health care service utilization health knowledge innovation insight knowledge base longitudinal analysis mortality opioid epidemic opioid mortality opioid overdose opioid use disorder prior authorization programs relapse risk treatment services trend

项目摘要

PROJECT SUMMARY As the nation continues to grapple with a rapidly changing epidemic of opioid overdose and mortality, there has been increasing public attention devoted to expanding access to opioid use disorder (OUD) treatment. While Medicaid is positioned to be a key policy lever to improve access to OUD treatment and reduce mortality among vulnerable populations, many state Medicaid programs do not cover the full continuum of OUD treatment and use utilization management parameters that may restrict access. Moreover, most state Medicaid programs contract with managed care organizations (MCOs). While over 70% of all Medicaid enrollees participate in MCO plans, little is known about how these plans cover OUD treatment. To fill this gap in the scientific evidence, we will conduct the first multi-state study of the effects of Medicaid MCO coverage and utilization management design on OUD treatment receipt and outcomes. The study will break new ground by encompassing all MCO plans, across multiple states, for the full continuum of treatment. We also propose to make use of innovative random auto-assignment methods in two state Medicaid programs. Our specific aims will include: estimating how state Medicaid program contractual regulations and oversight are associated with MCO plan level coverage and utilization design; estimating how MCO plans’ coverage and utilization management design are associated with progression through the Cascade of Care (diagnosis, engagement, medication initiation, and retention); and estimating how MCO plans’ coverage and utilization management parameters are associated with opioid-related emergency department visits, hospitalizations, and mortality. The proposed study will be the first comprehensive investigation of the effects of MCO coverage for OUD treatment services and medications on treatment receipt and outcomes – evidence without which the care of a large fraction of the OUD population is compromised. The study will also produce new insight into how states are regulating and monitoring MCO plan coverage and utilization management design. In the midst of the deadliest drug epidemic in the nation’s history, evidence regarding the impact of Medicaid MCO coverage for OUD treatment is urgently needed. This research will equip policymakers with evidence-based guidance on how to structure MCO contractual arrangements to ensure appropriate and efficient access to OUD treatment.

项目摘要随着国家继续努力应对阿片类药物过量和死亡率的快速变化的流行越来越多的公众注意力致力于扩大对阿片类药物使用障碍（OUD）治疗的机会。尽管医疗补助是改善获得OUD治疗并降低死亡率的关键政策杠杆在脆弱的人群中，许多州医疗补助计划并不涵盖OUD的完整连续性治疗和使用使用管理参数可能会限制访问。而且，大多数州医疗补助计划与托管护理组织（MCO）合同。虽然超过70％的医疗补助注册参加MCO计划，对这些计划如何涵盖Oud治疗知之甚少。填补这个空白科学证据，我们将对医疗补助MCO覆盖范围的影响和 OUD治疗收据和结果的利用管理设计。这项研究将通过涵盖了跨多个州的所有MCO计划，以进行全面的治疗。我们还建议在两个州医疗补助计划中使用创新的随机自动分配方法。我们的具体目标将包括：估计州医疗补助计划转换器法规和监督如何相关 MCO计划水平覆盖范围和利用设计；估计MCO计划的覆盖范围和利用管理设计与级联护理（诊断，参与，药物启动和保留）；并估计MCO计划的覆盖范围和利用管理如何参数与阿片类药物相关的急诊就诊，住院和死亡率有关。拟议的研究将是对MCO覆盖范围OUD影响的首次全面研究治疗服务和治疗收据和结果的药物 - 没有证据大部分OUD人口受到损害。这项研究还将对国家的状态产生新的见解正在监管和监视MCO计划覆盖范围和利用管理设计。在美国历史上最致命的药物流行，有关医疗补助MCO覆盖范围影响的证据迫切需要使用Oud治疗。这项研究将使政策制定者对有关证据的指导如何构建MCO合同安排，以确保适当有效地获得OUD治疗。