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在种族/民族中高得不成比例，而且还在上升。 在少数群体、妇女和农村地区。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)患者接受了循证治疗 治疗方面，种族/族裔少数群体和妇女不太可能获得治疗。治疗的障碍 包括污名、治疗环境诉求和医疗保险福利设计。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7700多万美国人提供医疗保险，其中包括规模庞大且不成比例的 少数族裔、妇女和农村美国人所占的比例。几乎所有的州医疗补助计划都与 医疗补助管理的医疗组织(MMCO)提供和管理医疗服务，近70% 的医疗补助参与者现在处于管理型医疗保健中。MMCO必须遵守国家的要求和政策，但 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， 关于毒品和犯罪问题办公室与酒精治疗服务有关的政策，几乎没有任何信息或透明度。这 这项研究系统地检查了MMCO的AUD治疗政策，这是一个未被充分探索的重要水平 做出的决定会影响获取机会和结果。我们将对MMCO和LINK进行全国性调查 他们对患者级别的医疗补助数据的反应。具体目标是：1)检测医疗补助MMCO酒精 跨MMCO的处理政策(例如覆盖范围、使用管理、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 根据州医疗补助政策制定的治疗政策。2)评估MMCO政策与获取 按种族/族裔分列的AUD治疗(例如，开始和参与治疗、住院后的后续治疗)， 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、药物治疗持续时间、住院、急诊室就诊)按种族/民族， 性别和城乡地理。我们的跨学科团队是独一无二的合格的指挥经验 之前的四项商业健康计划行为健康研究，并进行了严格的差异和 医疗补助分析。调查结果将提供关于MMCO政策及其与 种族/族裔少数群体和其他美国人的机会、治疗吸引力和费用。此信息可以是 由计划管理员在制定和实施政策时使用，在签订合同时由州医疗补助主任使用 与MMCO和联邦政策制定者就医疗补助豁免和其他事项做出决定 努力改善美国获得酒精治疗的机会。

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.