Improving value-based healthcare delivery for opioid use disorder

项目摘要 阿片类药物使用障碍(OUD)是导致死亡、残疾和医疗费用的越来越常见的原因 系统。尽管存在循证的OUD治疗，但吸收能力往往很差；而那些经常患有OUD的患者 有与健康相关的深刻社会需求，这使他们的护理复杂化。改善OUD的结果不取决于 不仅在治疗效果上，而且在优化医疗保健提供和支付系统方面也是如此 部署了有效的治疗方法。基于价值的护理-旨在实现以下目标的医疗保健提供和支付模式 激励价值而不是医疗量-代表着一种被吹捧的医疗改革的广泛方法 因为它有潜力改善OUD护理过程和结果。然而，尽管有这样的承诺， 在我们对基于价值的护理是否以及如何提高质量的理解中仍然存在知识差距 关爱有精神障碍的人。因此，这项K01提案利用一个机会来评估 在马萨诸塞州实施创新的新方案的背景下，提供基于价值的保健服务 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 这是第一个不仅基于受益人的医疗复杂性，而且还基于行为的ACO付款 健康和社会复杂性。研究的目的是将这一新颖的蚁群算法的实现作为一种 自然实验1)评估基于价值的护理改革对妇幼保健质量的影响，2)了解 目前设定ACO报酬的风险调整方法是否足以覆盖社会护理成本 有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。首席调查员许海瑟博士是一名职业生涯早期的临床医生兼调查员，在 在传染病流行病学、卫生服务研究和 以价值为基础的护理。凭借这款K01，她试图将她的临床研究重点转移到物质使用上， 专注于开发成瘾保健服务方面的内容专业知识和高级方法技能 质量和付款的准实验研究设计和风险调整。许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， 在成瘾医学和研究方面处于全国领先地位，并拥有美国最大的医疗补助ACO群体 马萨诸塞州。该提案得到了一个具有专业知识的跨学科指导和咨询团队的支持 在成瘾医学、物质使用研究、健康的社会决定因素、病因的先进方法方面 推论、卫生经济学、计量经济学和风险调整。培训将通过 紧密结合正规课程、研讨会、实地经验、应用研究经验、指导 教程，以及专注的指导。在K01颁奖期结束时，许博士将处于有利地位， 完成她的长期目标，成为一名独立的调查者和改善基于价值的 向有物质使用障碍的人提供医疗服务。

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.