Assessment of the Massachusetts Flexible Services Program to Address Food and Housing Insecurity in a Medicaid Accountable Care Organization.
Assessment of the Massachusetts Flexible Services Program to Address Food and Housing Insecurity in a Medicaid Accountable Care Organization.
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DOI：
10.1001/jamahealthforum.2023.1191
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发表时间：
2023-06-02
期刊：
影响因子：
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通讯作者：
Thorndike, Anne N
中科院分区：
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作者：
McCurley, Jessica L;Fung, Vicki;Levy, Douglas E;McGovern, Sydney;Vogeli, Christine;Clark, Cheryl R;Bartels, Stephen;Thorndike, Anne N
参与马萨诸塞州灵活服务计划以解决食品和住房不安全问题的医疗补助责任护理组织最初的实施挑战和解决方案是什么？在这项混合方法的定性评估中，实施挑战包括行政负担、影响社会需求筛选的新冠肺炎因素、数据跟踪和共享以及与社区组织的协调。适应性解决方案包括招聘登记工作人员的行政资金、与社区合作伙伴的双向沟通、识别符合条件的患者的新战略，以及提高临床医生对马萨诸塞州灵活服务计划的认识。未来州和卫生系统解决与健康相关的社会需求的计划可能受益于最大限度地减少行政负担，为登记人员和评估提供资金，并开发有效的信息共享平台。卫生系统正在越来越多地满足与卫生相关的社会需求。马萨诸塞州灵活服务计划(Flex)是一项为期3年的试点计划，旨在通过将医疗补助责任护理组织(ACO)的注册者与社区资源联系起来，解决食品不安全和住房不安全问题。了解计划前17个月在1个Medicaid ACO中实施Flex的障碍和促进者。这项从2020年3月到2021年7月的混合方法定性评估研究使用了REACH、有效性、采用、实施、维护/实用、稳健实施和可持续发展模型(RE-AIM/PRISM)框架。分析包括两家马萨诸塞州布里格姆综合医院(MGB)和附属社区卫生中心。量化数据包括所有MGB医疗补助ACO参与者。对15名ACO工作人员和17名Flex参与者进行了定性访谈。REACH是根据完成年度社会需求筛选(例如，食品不安全和住房不安全)的ACO参与者的比例以及Flex参与者的比例和人口统计数据进行评估的。定性访谈考察了RE-AIM/PRISM的其他结构(例如，实施挑战、促进者和感知的有效性)。在2020年3月至2021年7月的67名 098医疗补助ACO参与者(平均年龄28.8[18.7]岁)中，38名 442(57.3%)完成了至少一次社会需求筛查；10名 730(16.0%)筛查呈食品不安全，7 401(11.0%)呈住房不安全筛查阳性。Flex有658名(1.6%)成年人(平均年龄46.6[11.8]岁)和173名(0.7%)儿童(<；21岁；平均[SD]年龄10.1[5.5])；在这831人中，613人(73.8%)是女性，444(53.4%)是西班牙裔/拉丁裔，172(20.7%)是黑人。大多数Flex参与者(584[88.8%]成人；143[82.7%]儿童)获得了预期的营养或住房服务。受访工作人员确定的实施挑战包括行政负担、与社区组织的协调、数据共享和信息共享以及新冠肺炎因素(例如，减少临床就诊)。实施促进者包括为登记工作人员提供行政资金、与社区合作伙伴进行双向沟通、识别符合条件的患者的适应性战略以及提高临床医生对Flex的认识。在Flex参与者的访谈中，那些接受营养服务的人报告说，他们的健康饮食和食品安全得到了提高；他们也报告了比接受住房服务的Flex参与者更高的计划满意度。接受了允许根据偏好选择食物的营养服务的参与者报告的满意度高于那些不能选择食物的人。这项混合方法的定性评估研究发现，为了改善实施情况，满足社会需求的医疗补助和卫生系统计划可能受益于为行政成本提供资金、开发双向数据共享平台以及根据患者偏好定制支持。这项定性研究试图了解在2020年3月至2021年7月的前17个月内，马萨诸塞州医疗补助计划灵活服务计划在医疗补助责任护理组织中实施的障碍和促进者。
What were the initial implementation challenges and solutions for a Medicaid accountable care organization participating in the Massachusetts Flexible Services program to address food and housing insecurity? In this mixed-methods qualitative evaluation, implementation challenges included administrative burden, COVID-19 factors that influenced screening for social needs, data tracking and sharing, and coordinating with community organizations. Adaptive solutions included administrative funding for hiring enrollment staff, bidirectional communication with community partners, new strategies to identify eligible patients, and raising clinician awareness of the Massachusetts Flexible Services program. Future state and health systems’ programs to address health-related social needs may benefit from minimizing administrative burden, providing funding for enrollment staff and evaluation, and developing effective information-sharing platforms. Health systems are increasingly addressing health-related social needs. The Massachusetts Flexible Services program (Flex) is a 3-year pilot program to address food insecurity and housing insecurity by connecting Medicaid accountable care organization (ACO) enrollees to community resources. To understand barriers and facilitators of Flex implementation in 1 Medicaid ACO during the first 17 months of the program. This mixed-methods qualitative evaluation study from March 2020 to July 2021 used the Reach, Efficacy, Adoption, Implementation, Maintenance/Practical, Robust Implementation, and Sustainability Model (RE-AIM/PRISM) framework. Two Mass General Brigham (MGB) hospitals and affiliated community health centers were included in the analysis. Quantitative data included all MGB Medicaid ACO enrollees. Qualitative interviews were conducted with 15 members of ACO staff and 17 Flex enrollees. Reach was assessed by the proportion of ACO enrollees who completed annual social needs screening (eg, food insecurity and housing insecurity) and the proportion and demographics of Flex enrollees. Qualitative interviews examined other RE-AIM/PRISM constructs (eg, implementation challenges, facilitators, and perceived effectiveness). Of 67 098 Medicaid ACO enrollees from March 2020 to July 2021 (mean [SD] age, 28.8 [18.7] years), 38 442 (57.3%) completed at least 1 social needs screening; 10 730 (16.0%) screened positive for food insecurity, and 7401 (11.0%) screened positive for housing insecurity. There were 658 (1.6%) adults (mean [SD] age, 46.6 [11.8] years) and 173 (0.7%) children (<21 years; mean [SD] age, 10.1 [5.5]) enrolled in Flex; of these 831 people, 613 (73.8%) were female, 444 (53.4%) were Hispanic/Latinx, and 172 (20.7%) were Black. Most Flex enrollees (584 [88.8%] adults; 143 [82.7%] children) received the intended nutrition or housing services. Implementation challenges identified by staff interviewed included administrative burden, coordination with community organizations, data-sharing and information-sharing, and COVID-19 factors (eg, reduced clinical visits). Implementation facilitators included administrative funding for enrollment staff, bidirectional communication with community partners, adaptive strategies to identify eligible patients, and raising clinician awareness of Flex. In Flex enrollee interviews, those receiving nutrition services reported increased healthy eating and food security; they also reported higher program satisfaction than Flex enrollees receiving housing services. Enrollees who received nutrition services that allowed for selecting food based on preferences reported higher satisfaction than those not able to select food. This mixed-methods qualitative evaluation study found that to improve implementation, Medicaid and health system programs that address social needs may benefit from providing funding for administrative costs, developing bidirectional data-sharing platforms, and tailoring support to patient preferences. This qualitative study sought to understand the barriers and facilitators of Massachusetts Medicaid’s Flexible Services Program implementation in a Medicaid accountable care organization during the first 17 months from March 2020 to July 2021.