Improving value-based healthcare delivery for opioid use disorder

项目摘要 阿片类药物使用障碍（OUD）是一种越来越常见的死亡，残疾和医疗费用的原因 系统虽然存在基于证据的OUD治疗，但接受率往往很低; OUD患者经常 有深刻的健康相关的社会需求，使他们的护理复杂化。改善OUD的结果并不取决于 不仅关注治疗效果，还关注优化医疗保健服务和支付系统， 部署有效的治疗。基于价值的护理-一种医疗保健服务和支付模式，旨在 激励价值而不是护理量-代表了一种广泛的医疗保健改革方法， 因为它有潜力改善OUD护理过程和结果。尽管如此，大 在我们对基于价值的护理是否以及如何提高质量的理解方面，仍然存在知识差距 照顾有OUD的人。因此，本K 01提案利用机会评估以下方面的有效性： 在马萨诸塞州实施创新的新的 医疗补助责任护理组织（ACO）的护理模式。马萨诸塞州医疗补助ACO计划是 这是第一个不仅根据受益人的医疗复杂性， 健康和社会复杂性。研究的目的是使用这种新的ACO程序的实施， 自然实验，以1）评估基于价值的护理改革对OUD护理质量的影响，2）了解 目前确定ACO付款的风险调整方法是否足以覆盖社会护理费用 OUD和住房不稳定的复杂患者，以及3）开发OUD护理的试点风险调整模型 质量措施。主要研究者石楠许博士是一名早期职业临床研究者， 在传染病流行病学，卫生服务研究， 基于价值的护理有了这个K 01，她试图将她的研究的临床重点转移到物质使用， 专注于开发成瘾医疗保健提供方面的内容专业知识和先进的方法学技能， 准实验研究设计和质量和支付的风险调整。徐博士将获得这些技能 并在波士顿医学中心和波士顿大学医学院进行拟议的研究， 在成瘾医学和研究的国家领导人和家庭最大的医疗补助ACOs组在 马萨诸塞州。该提案得到了具有专业知识的跨学科导师和咨询团队的支持 在成瘾医学，物质使用研究，健康的社会决定因素，因果关系的先进方法， 推理、卫生经济学、计量经济学和风险调整。培训将通过一个 正式课程，研讨会，实地经验，应用研究经验的密集结合，指导 辅导和集中指导。在K 01奖励期结束时，徐博士将处于有利地位， 实现她的长期目标，成为一个独立的调查员和专家，改善基于价值的 向有物质使用障碍的人提供保健服务。

Project Summary Opioid use disorder (OUD) is an increasingly common cause of death, disability, and cost to the healthcare system. Though evidence-based OUD treatment exists, uptake is often poor; and those with OUD frequently have profound health-related social needs that complicate their care. Improving OUD outcomes depends not only on treatment efficacy, but also on optimizing the healthcare delivery and payment systems in which efficacious treatments are deployed. Value-based care – a healthcare delivery and payment model that aims to incentivize value rather than volume of care – represents a widespread approach to healthcare reform touted for its potential to improve OUD care processes and outcomes. Despite this promise, however, large knowledge gaps remain in our understanding of whether – and how – value-based care may promote quality care for people with OUD. This K01 proposal therefore leverages an opportunity to assess the effectiveness of value-based care delivery for OUD in the context of Massachusetts’ implementation of an innovative new Medicaid accountable care organization (ACO) model of care. The Massachusetts Medicaid ACO program is the first of its kind to base ACO payments not only on beneficiaries’ medical complexity, but also on behavioral health and social complexity. The research aims are to use implementation of this novel ACO program as a natural experiment to 1) assess the impact of value-based care reform on OUD care quality, 2) understand whether current risk adjustment methods for setting ACO payments adequately cover costs of care for socially complex patients with OUD and housing instability, and 3) develop a pilot risk adjustment model for OUD care quality measures. The Principal Investigator, Dr. Heather Hsu, is an early career clinician-investigator with prior research experience at the intersection of infectious disease epidemiology, health services research, and value-based care. With this K01, she seeks to transition the clinical focus of her research to substance use, focusing on developing content expertise in addiction healthcare delivery and advanced methodologic skills in quasi-experimental study design and risk adjustment for quality and payment. Dr. Hsu will acquire these skills and conduct the proposed research at Boston Medical Center and Boston University School of Medicine, national leaders in addiction medicine and research and home to the largest group of Medicaid ACOs in Massachusetts. The proposal is supported by an interdisciplinary mentorship and advisory team with expertise in addiction medicine, substance use research, social determinants of health, advanced methods for causal inference, health economics, econometrics, and risk adjustment. Training will be accomplished through an intensive combination of formal coursework, workshops, field experience, applied research experience, guided tutorials, and focused mentorship. At the end of the K01 award period, Dr. Hsu will be well-positioned to accomplish her long-term goal to become an independent investigator and expert on improving value-based healthcare delivery to persons with substance use disorders.