Treatment for Alcohol Use Disorder in Medicaid Managed Care

医疗补助管理护理中酒精使用障碍的治疗

• 批准号: 10403668
• 负责人: Amanda J Abraham
• 金额: $ 62.57万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-10 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10403668
• 关键词: AODR mortality; Accounting; Address; Affect; Age; Alcohols; American; Behavior Therapy; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Contracts; Data; Data Set; Diagnosis; Emergency department visit; Ensure; Health; Health Services Accessibility; Heavy Drinking; Hospitalization; Improve Access; Investigation; Kentucky; Link; Managed Care; Medicaid; Methods; Morality; Ohio; Outcome; Patients; Pharmaceutical Preparations; Policies; Population; Positioning Attribute; Public Health; Randomized; Relapse; Research; Selection Bias; Series; Structure; Substance Use Disorder; Time; United States; Vulnerable Populations; acute care; adverse outcome; alcohol abuse therapy; alcohol availability; alcohol use disorder; craving; design; evidence base; health knowledge; indexing; innovation; knowledge base; longitudinal analysis; medication compliance; mortality; overtreatment; prior authorization; programs; public health priorities; treatment effect; treatment services

PROJECT SUMMARY As the nation continues to grapple with rising alcohol-related hospitalization and mortality, expanding access to alcohol use disorder (AUD) treatment remains an urgent public health priority. While Medicaid is positioned to be a key policy lever to improve access to AUD treatment and reduce mortality among vulnerable populations, many state Medicaid programs do not cover the full continuum of AUD 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 AUD 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 AUD treatment receipt and outcomes. The study will encompass 142 MCO plans, across 18 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: (1) estimating how MCO plans’ coverage and utilization management designs are associated with progression through the major stages of identification and treatment of AUD (diagnosis, initiation, engagement, and retention); (2) estimating how MCO plans’ coverage and utilization management parameters are associated with alcohol-related emergency department visits and hospitalizations; and (3) estimating how progression through the stages of identification and treatment of AUD is associated with alcohol-related mortality. The proposed study will be the first comprehensive investigation of the effects of MCO coverage for AUD treatment on treatment receipt and outcomes – evidence without which the care of a large fraction of the AUD population is compromised. As alcohol-related hospitalization and mortality continue to rise, evidence regarding the impact of Medicaid MCO coverage for AUD 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 AUD treatment. 1

项目概要 随着国家继续努力应对与酒精相关的住院率和死亡率上升的问题，扩大获得服务的机会 酒精使用障碍 (AUD) 治疗仍然是一个紧迫的公共卫生优先事项，而医疗补助计划的定位是。 成为改善弱势群体获得 AUD 治疗并降低死亡率的关键政策杠杆， 许多州的医疗补助计划不涵盖 AUD 治疗和使用的整个连续过程 此外，大多数州的医疗补助计划都与可能限制访问的管理参数签订了合同。 虽然超过 70% 的医疗补助参与者参加了 MCO 计划，但很少有人参与管理式医疗组织 (MCO)。 了解这些计划如何涵盖 AUD 治疗 为了填补科学证据的这一空白，我们将进行。 第一个关于医疗补助 MCO 覆盖范围和使用管理设计对澳元影响的多州研究 该研究将涵盖 18 个州的 142 个 MCO 计划。 我们还建议在两种情况下使用创新的随机自动分配方法。 我们的具体目标包括：(1) 估计 MCO 计划的覆盖范围和范围。 利用管理设计与识别和识别的主要阶段的进展相关联。 AUD 的治疗（诊断、启动、参与和保留）；(2) 估计 MCO 计划的覆盖范围 和利用管理参数与酒精相关的急诊科就诊和 住院治疗；(3) 估计 AUD 的识别和治疗阶段的进展情况 与酒精相关的死亡率相关。拟议的研究将是第一个全面调查。 AUD 治疗的 MCO 覆盖范围对治疗接受和结果的影响 – 没有证据 由于与酒精相关的住院治疗和治疗，很大一部分澳元人口的护理受到影响。 死亡率持续上升，有关医疗补助 MCO 覆盖范围对 AUD 治疗影响的证据是 这项研究将为政策制定者提供关于如何构建的基于证据的指导。 MCO 合同安排，确保适当且有效地获得 AUD 待遇。 1