Effect of Medicaid Accountable Care Organizations on Behavioral Health Care Quality and Outcomes for Children

医疗补助责任护理组织对儿童行为保健质量和结果的影响

基本信息

批准号：
10729117
负责人：
Kimberley Lynn H Geissler
金额：
$ 79.78万
依托单位：
UNIVERSITY OF MASSACHUSETTS AMHERST
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-12 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10729117
关键词：
18 year old Accountability Address Adult Affect Age COVID-19 pandemic Caring Characteristics Child Child Care Child health care Childhood Chronic Disease Community Healthcare Consultations Contracts Data Databases Diagnosis Diagnostic Services Disease Disparity Enrollment Evidence based treatment Exposure to Future Gender Health Health Insurance Health Personnel Health Services Healthcare Healthcare Systems Heterogeneity High Prevalence Hospitals Improve Access Incentives Insurance Coverage Intervention Interview Knowledge Low income Massachusetts Measures Medicaid Methods Minority Groups Natural experiment Organizational Models Outcome Ownership Parents Patients Physicians Policy Maker Population Prevalence Privatization Provider Psychiatry Quality Indicator Quality of Care Race Reporting Self-Injurious Behavior Sexuality Surveys Telephone Vulnerable Populations accountable care organization acute care adverse childhood events aged autism spectrum disorder behavioral health beneficiary care coordination community based service coronavirus disease ethnic disparity ethnic minority population experience experimental study health care delivery health care disparity health care quality health organization high risk high risk population improved informant innovation insurance plan low socioeconomic status medical specialties member novel pediatrician population health primary care practice primary care provider primary care setting programs racial disparity racial minority population satisfaction social health determinants social stigma socioeconomic disparity therapy development treatment services

项目摘要

PROJECT SUMMARY One in six children aged 6-17 years had a behavioral health (BH) diagnosis in 2016, with estimates climbing to more than one in four during the COVID-19 pandemic. Limited access to BH services has long presented challenges for most children. Efforts to address the shortcomings of the specialty BH care system, such as integrating BH care into pediatric primary care settings, and state programs that offer telephonic psychiatry consultation to pediatricians, have helped improve care, but immense gaps in care and disparities persist. Accountable care organizations (ACOs) incentivize care integration and population health, which promotes community-health care linkages, care coordination, and interventions to address social determinants of health. The innovative reform introduced by ACOs has the potential to improve BH care delivery, but their impact for pediatric populations is largely unknown. Studies of adult populations suggest that ACOs with certain organizational features (e.g., type of contract) may improve quality of care for chronic diseases but the few studies of the impact of ACOs on quality of care and outcomes for children have not focused on this large, high-risk population of children with BH disorders. This study will be the first to address this critical gap in knowledge by taking advantage of the natural experiment taking place in Massachusetts (MA), a state with a high prevalence of children with BH diagnoses. In 2018, MA, launched 17 new Medicaid ACOs with heterogeneous organizational features (e.g., size; physician vs. hospital-led; age mix. We will leverage MA’s innovative Medicaid ACO ‘experiment’ to address the following aims using mixed methods: 1) Evaluate the impact of ACOs on BH care quality, outcomes, and disparities for Medicaid-insured children; 2) Discern how ACO heterogeneity modifies ACOs’ effects on BH quality and outcomes; 3) Determine the relationship between parent reported experience with their child’s Behavioral Health care and organizational features of the Medicaid ACOs. Fundamental changes in healthcare are needed to address socioeconomic and racial/ethnic disparities in BH care quality and outcomes for children in vulnerable populations. Our innovative mixed methods approach to examining the association between exposure to a new heterogeneous group of Medicaid ACOs and BH care and outcomes uses state-level administrative claims and survey data and key informant interviews with ACO leaders and parents to begin to address this large gap in knowledge. This new information is expected to benefit providers, payers, and policy makers responsible for the care of vulnerable populations of children with BH disorders.

项目概要 2016 年，六分之一的 6-17 岁儿童被诊断为行为健康 (BH)，估计值攀升至长期以来，超过四分之一的人在 COVID-19 大流行期间获得 BH 服务的机会有限。大多数儿童面临的挑战。努力解决专业 BH 护理系统的缺点，例如将 BH 护理纳入儿科初级护理机构以及提供电话精神病学的国家计划向儿科医生咨询有助于改善护理，但护理方面的巨大差距和差异仍然存在。责任护理组织 (ACO) 激励护理整合和人口健康，从而促进社区与卫生保健的联系、护理协调以及解决健康问题社会决定因素的干预措施。 ACO 引入的创新改革有可能改善 BH 护理服务，但其影响对成人人群的研究表明，ACO 与某些儿童人群的关系很大程度上是未知的。组织特征（例如合同类型）可能会提高慢性病的护理质量，但很少有关于 ACO 对儿童护理质量和结果的影响的研究并未集中于如此大的、这项研究将是第一个解决 BH 疾病高危儿童群体的研究。通过利用在马萨诸塞州 (MA) 进行的自然实验来获取知识，该州拥有患有 BH 诊断的儿童的患病率很高。2018 年，马萨诸塞州推出了 17 项新的医疗补助 ACO，其中包括：异质的组织特征（例如，规模；医生与医院主导；年龄组合。我们将利用 MA 的创新的医疗补助 ACO“实验”使用混合方法来实现以下目标： 1) 评估 ACO 对 BH 护理质量、结果和医疗补助保险儿童差异的影响 2) 了解如何进行； ACO 异质性改变了 ACO 对 BH 质量和结果的影响 3) 确定关系；家长报告的孩子行为健康护理经验与机构的组织特征之间的关系医疗补助 ACO 需要对医疗保健进行根本性变革，以解决社会经济和种族/民族问题。 BH 弱势群体儿童的护理质量和结果存在差异。方法检验暴露于新的异质医疗补助群体之间关联的方法 ACO 和 BH 护理和结果使用州级行政索赔和调查数据以及关键信息提供者与 ACO 领导和家长进行访谈，开始解决这一新信息的巨大知识差距。预计将使负责照顾弱势群体的提供者、付款者和政策制定者受益患有 BH 疾病的儿童。