Alcohol treatment in Medicaid managed care plans: Disparities in policies and outcomes

医疗补助管理式医疗计划中的酒精治疗：政策和结果的差异

• 批准号: 10372687
• 负责人: Maureen T Stewart
• 金额: $ 60.31万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10372687
• 关键词: Address; Administrator; Alcohol consumption; Alcohols; American; Area; Behavior Therapy; COVID-19; Caring; Contracts; Data; Decision Making; District of Columbia; Emergency department visit; Equilibrium; Ethnic Origin; Evidence based treatment; FDA approved; Gender; Geography; Goals; Health; Health Insurance; Health Services; Health Services Accessibility; Hospitalization; Improve Access; Insurance Benefits; Link; Mainstreaming; Managed Care; Managed Care Programs; Medicaid; Medical; Morbidity - disease rate; Organizational Policy; Outcome; Patients; Pharmaceutical Preparations; Pharmacotherapy; Police; Policies; Policy Maker; Population; Race; Regulation; Reporting; Rural; Surveys; Treatment Cost; Treatment outcome; United States; Woman; addiction; alcohol abuse therapy; alcohol availability; alcohol misuse; alcohol use disorder; alcohol-related death; barrier to care; behavioral health; binge drinking; care outcomes; cost; design; ethnic minority population; experience; federal policy; follow-up; health care service; health disparity; health management; health plan; improved; innovation; mortality; programs; provider networks; racial and ethnic; racial difference; racial minority; response; rural Americans; rural area; rural setting; social health determinants; social stigma; success; tool; treatment services; waiver

Rates of alcohol-related morbidity and mortality are disproportionately high and increasing among racial/ethnic minorities and women and in rural areas. Almost 90,000 Americans die annually from alcohol use. Despite the health consequences, fewer than 10% of those with alcohol use disorder (AUD) receive evidence-based treatment, and racial/ethnic minorities and women are less likely to access treatment. Barriers to treatment include stigma, treatment setting appeal, and health insurance benefit design. Medicaid programs are among the most important payers for AUD treatment and rates of AUD in the Medicaid population are especially high. Medicaid provides health insurance for more than 77 million Americans, including a large and disproportionate share of racial/ethnic minorities, women, and rural Americans. Almost all state Medicaid programs contract with Medicaid managed care organizations (MMCOs) to deliver and manage health care services and nearly 70% of Medicaid enrollees are now in managed care. MMCOs must adhere to state requirements and policies, but have considerable discretion over polices that may influence access, treatment appeal, and cost. However, there is almost no information or transparency on MMCO polices related to alcohol treatment services. This study systematically examines AUD treatment policies in MMCOs, an under-explored level where important decisions are made that influence access and outcomes. We will conduct a national survey of MMCOs and link their responses to patient-level Medicaid data. The specific aims are: 1) Examine Medicaid MMCO alcohol treatment policies (e.g. coverage, utilization management, provider networks, innovations) across MMCOs that contract with the 50 states and District of Columbia; determine whether there are differences in MMCO alcohol treatment policies by state Medicaid policies. 2) Assess the relationship between MMCO policies and access to AUD treatment (e.g. initiation and engagement in treatment, follow-up after hospitalization) by race/ethnicity, gender, and rural/urban geography. 3) Assess the relationship between MMCO policies and alcohol treatment outcomes (i.e.. treatment retention, pharmacotherapy duration, hospitalization, ED visit) by race/ethnicity, gender and rural/urban geography. Our interdisciplinary team is uniquely qualified with experience conducting four previous commercial health plan behavioral health studies, and conducting rigorous disparities and Medicaid analyses. Findings will provide valuable information on MMCO policies and their associations with access, treatment appeal and cost for racial/ethnic minorities and other Americans. This information can be used by plan administrators as they develop and implement policies, state Medicaid directors as they contract with and regulate MMCOs, and federal policy makers making determinations about Medicaid waivers and other efforts to improve access to alcohol treatment in the US.

与酒精有关的发病率和死亡率高得不成比例，而且在种族/族裔中还在增加