Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York.
Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York.
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DOI：
10.1001/jamahealthforum.2022.1771
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发表时间：
2022-07
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在纽约，医疗补助管理保健(MMC)计划在涵盖物质使用障碍(SUD)治疗方面的可及性、质量和结果指标如何？在这项横断面研究中，对159名 016成人医疗补助受助者的管理记录进行了研究，这些受助者没有选择计划，可以被认为是跨计划随机分配的人，在所有计划中，对SUD治疗的参与度都很低。各计划之间的支出差异很大，有几个计划在SUD服务上的支出较低，各计划之间的结果差别不大，绩效较低。研究结果表明，有必要改进对医疗补助私人计划绩效的监测。对医疗补助管理保健(MMC)私人计划在涵盖物质使用障碍(SUD)治疗方面的表现的评估有限。比较MMC计划在获得、质量和SUD治疗结果的19个指标上的表现。这项横断面研究使用行政索赔和强制分配计划，从2009年1月到2017年12月，居住在纽约州5个县(区)中的1个县(区)的多达159名 016成人医疗补助接受者，以确定不同类型的MMC计划在SUD治疗机会、模式和结果方面的差异。2019年10月从纽约州卫生部收到了最近几年的数据，此后不久就开始了分析。大约17%的人没有主动选择计划，其中的一部分(大约4%)可以被视为随机分配。计划分配。在获得SUD治疗的途径、过程和结果的19个指标中实现绩效衡量的参与者百分比。对自动分配到MMC计划的159名 016成年人(平均年龄35.9[12.7]岁；74名 261名女性[46.7%]；8746名[5.5%]亚裔；73名 783[46.4%]黑人和40名 549[25.5%]白人)的医疗补助申请数据进行了分析。与国家模式一致，所有计划在大多数业绩衡量标准上的实现程度都低于50%(范围为0%-62.1%)。在所有计划中，除阿片类障碍治疗外，酒精(0%-0.4%)和烟草治疗(0.8%-7.2%)的治疗参与度较低(41.5%-61.4%)。在准入措施方面，9个计划中有4个在承认SUD诊断、首次使用任何服务和烟草使用筛查方面的表现明显高于平均值。在过程措施中，每月用于SUD治疗的总支出是计划与平均值显著不同的唯一指标。结果衡量标准在不同的计划中几乎没有区别。这项横断面研究的结果表明，需要在让患者参与SUD治疗方面取得进展，并改善纽约SUD护理的低绩效和MMC计划的有限变化。医疗补助中SUD治疗的整体表现的改善可能取决于一般计划的改进，而不是在计划之间转移接受者。这项横断面研究通过药物使用障碍治疗的获取、质量和结果的19个指标检查了医疗补助管理保健计划的表现。
How do Medicaid managed care (MMC) plans compare in terms of covering substance use disorder (SUD) treatment across indicators of access, quality, and outcomes in New York, New York? In this cross-sectional study of administrative records from 159 016 adult Medicaid recipients who did not choose a plan and who could be regarded as randomly assigned across plans, engagement in SUD treatment was low across all plans. There was significant expenditure variation among plans, with several plans with low spending on SUD services, and outcomes differed little across plans, with low performance. The study findings suggest a need for improved monitoring of the performance of Medicaid private plans. There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment. To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment. This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patterns, and outcomes among different types of MMC plans. Data from the latest years were received from the New York State Department of Health in October 2019, and analysis began soon thereafter. Approximately 17% did not make an active choice of plan, and a subset of these (approximately 4%) can be regarded as randomly assigned. Plan assignment. Percentage of the enrollees achieving performance measures across 19 indicators of access, process, and outcomes of SUD treatment. Medicaid claims data from 159 016 adults (mean [SD] age, 35.9 [12.7] years; 74 261 women [46.7%]; 8746 [5.5%] Asian, 73 783 [46.4%] Black, and 40 549 [25.5%] White individuals) who were auto assigned to an MMC plan were analyzed. Consistent with national patterns, all plans achieved less than 50% (range, 0%-62.1%) on most performance measures. Across all plans, there were low levels of treatment engagement for alcohol (range, 0%-0.4%) and tobacco treatment (range, 0.8%-7.2%), except for engagement for opioid disorder treatment (range, 41.5%-61.4%). For access measures, 4 of the 9 plans performed significantly higher than the mean on recognition of an SUD diagnosis, any service use for the first time, and tobacco use screening. Of the process measures, total monthly expenditures on SUD treatment was the only measure for which plans differed significantly from the mean. Outcome measures differed little across plans. The results of this cross-sectional study suggest the need for progress in engaging patients in SUD treatment and improvement in the low performance of SUD care and limited variation in MMC plans in New York, New York. Improvement in the overall performance of SUD treatment in Medicaid potentially depends on general program improvements, not moving recipients among plans. This cross-sectional study examines the performance of Medicaid managed care plans across 19 indicators of access, quality, and outcomes of substance use disorder treatment.