The effects of behavioral health integration in Medicaid managed care on access to mental health and primary care services-Evidence from early adopters.
The effects of behavioral health integration in Medicaid managed care on access to mental health and primary care services-Evidence from early adopters.
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行为健康纳入医疗补助管理式医疗对获得心理健康和初级保健服务的影响 - 来自早期采用者的证据。
DOI：
10.1111/1475-6773.14132
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发表时间：
2023
影响因子：
3.4
通讯作者：
Zhu,JaneM
中科院分区：
文献类型：
--
作者：
McConnell,KJohn;Edelstein,Sara;Hall,Jennifer;Levy,Anna;Danna,Maria;Cohen,DeborahJ;Lindner,Stephan;Unützer,Jürgen;Zhu,JaneM
目的评估过渡到“综合管理式医疗”模式的影响，其中医疗补助管理式医疗机构从“开拓”模式转变为整合行为和身体健康护理融资的“切入”模式。数据来源/研究设置2014-2019年华盛顿州医疗补助索赔数据，研究设计这项混合方法研究使用差异中的差异模型，比较了两个过渡到金融一体化的国家的变化，2016年到10个比较县保持分割模型，结合15个关键线人访谈的定性分析。定量结果包括获得门诊精神卫生保健、初级保健、急诊科（艾德）和精神卫生条件住院治疗的二进制措施。数据收集医疗补助索赔行政收集，访谈记录，转录，主要发现向财务综合护理的过渡最初对行为健康提供者是破坏性的，在严重精神疾病（SMI）的登记者中，获得门诊精神卫生服务的机会暂时下降，但在第一年后没有统计学显著或持续的差异。患有重度精神障碍的入组者获得初级保健的机会也略有增加（1.8%，95% CI 1.0%-2.6%），但在使用艾德或住院服务进行精神卫生保健方面没有持续的统计学显著变化。过渡到财政上的综合保健对初级保健提供者的影响相对较小，有轻微，中度或无精神疾病的登记者的变化很少。ConclusionsFinancial整合的行为和身体健康在医疗补助管理的医疗似乎并没有推动临床转型，是破坏性的行为健康提供者。转向“切入”模式的国家可能需要纳入对实践转变的支持或财政激励措施，以实现协调的身心健康护理的益处。
ObjectiveTo evaluate the impacts of a transition to an “integrated managed care” model, wherein Medicaid managed care organizations moved from a “carve‐out” model to a “carve‐in” model integrating the financing of behavioral and physical health care.Data Sources/Study SettingMedicaid claims data from Washington State, 2014–2019, supplemented with structured interviews with key stakeholders.Study DesignThis mixed‐methods study used difference‐in‐differences models to compare changes in two counties that transitioned to financial integration in 2016 to 10 comparison counties maintaining carve‐out models, combined with qualitative analyses of 15 key informant interviews. Quantitative outcomes included binary measures of access to outpatient mental health care, primary care, the emergency department (ED), and inpatient care for mental health conditions.Data CollectionMedicaid claims were collected administratively, and interviews were recorded, transcribed, and analyzed using a thematic analysis approach.Principal FindingsThe transition to financially integrated care was initially disruptive for behavioral health providers and was associated with a temporary decline in access to outpatient mental health services among enrollees with serious mental illness (SMI), but there were no statistically significant or sustained differences after the first year. Enrollees with SMI also experienced a slight increase in access to primary care (1.8%, 95% CI 1.0%–2.6%), but no sustained statistically significant changes in the use of ED or inpatient services for mental health care. The transition to financially integrated care had relatively little impact on primary care providers, with few changes for enrollees with mild, moderate, or no mental illness.ConclusionsFinancial integration of behavioral and physical health in Medicaid managed care did not appear to drive clinical transformation and was disruptive to behavioral health providers. States moving towards “carve‐in” models may need to incorporate support for practice transformation or financial incentives to achieve the benefits of coordinated mental and physical health care.