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

与酒精有关的发病率和死亡率高得不成比例，并且在种族/族裔之间不断增加。 少数民族和妇女以及农村地区。每年有近9万美国人死于饮酒。尽管 健康后果，只有不到10%的酒精使用障碍（AUD）患者接受循证医学治疗。 少数种族/族裔和妇女获得治疗的可能性较小。治疗障碍 包括污名化、治疗设置上诉和健康保险福利设计。医疗补助计划是 AUD治疗的最重要支付者和医疗补助人群中的AUD比率特别高。 医疗补助计划为超过7700万美国人提供医疗保险，其中包括大量不成比例的医疗保险。 种族/少数民族，妇女和农村美国人的比例。几乎所有的州医疗补助计划都与 医疗补助管理医疗组织（MMCO）提供和管理医疗保健服务，近70% 的医疗补助注册者现在都在接受管理式护理。MMCO必须遵守国家的要求和政策， 对可能影响获取、治疗吸引力和成本的政策有相当大的自由裁量权。然而，在这方面， 几乎没有任何关于墨西哥医疗保健组织与酒精治疗服务有关的政策的信息或透明度。这 一项研究系统地检查了MMCO中的AUD处理政策，这是一个未充分探索的层面， 所作的决定影响到获取和结果。我们将在全国范围内对MMCO进行调查， 他们对病人医疗补助数据的反应。具体目标是：1）检查医疗补助MMCO酒精 跨MMCO的治疗政策（例如覆盖范围、利用管理、提供商网络、创新）， 与50个州和哥伦比亚特区签订合同;确定MMCO酒精是否存在差异 国家医疗补助政策。2)评估MMCO政策与获得 按人种/种族列出的AUD治疗（例如，开始和参与治疗，住院后随访）， 性别和城乡地理。3)评估MMCO政策与酒精治疗之间的关系 结果（即。治疗保留率、药物治疗持续时间、住院、艾德访视），按人种/种族， 性别和城乡地理。我们的跨学科团队是唯一合格的经验进行 四个以前的商业健康计划行为健康研究，并进行严格的差异， 医疗分析调查结果将提供有关MMCO政策及其与 少数种族/族裔和其他美国人的准入、治疗上诉和费用。该信息可以 供计划管理员在制定和实施政策时使用， 与监管MMCO，以及联邦政策制定者就医疗补助豁免和其他 努力改善美国的酒精治疗。

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.