The Effects of Statewide Comprehensive Integrated Care for Medicaid Enrollees.

全州范围内综合综合护理对医疗补助参与者的影响。

• 批准号: 10404642
• 负责人: Kenneth John McConnell
• 金额: $ 68.84万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10404642
• 关键词: Address; Adoption; Adult; Affect; Bipolar Disorder; Caring; Child; Client; Clinical; Communication; Contracts; County; Criminal Justice; Data; Database Management Systems; Effectiveness; Employment; Environment; Funding; General Population; Health Benefit; Health Expenditures; Health system; Healthcare; Healthcare Systems; Housing; Improve Access; Individual; Interview; Knowledge; Link; Major Depressive Disorder; Managed Care; Managed Care Programs; Measures; Medicaid; Mental Health; Mental Health Services; Mental disorders; Modeling; National Institute of Mental Health; Natural experiment; Outcome; Patient-Focused Outcomes; Patients; Persons; Policies; Population; Primary Health Care; Privatization; Public Health; Qualitative Methods; Research; Research Design; Resources; Risk; Schizophrenia; Services; Social Work; Specialist; Specific qualifier value; Structure; System; Testing; Time; Vital Statistics; Washington; Work; beneficiary; design; flexibility; housing instability; improved; improved outcome; insight; medical specialties; payment; physical conditioning; physical health service; programs; provider networks; public health insurance; randomized trial; response; severe mental illness; social health determinants

PROJECT SUMMARY The design of public insurance in providing mental health services is a critically important policy issue. A large number of studies have demonstrated substantial benefits for patients in integrated care models, which allow access to primary physical and mental health care in one setting. However, widespread adoption of integrated care models has not occurred. A critical and continuing barrier is the separation of financing and payment for physical and mental health services, particularly in the form of mental health “carve-outs” in Medicaid programs. Carve-outs are perceived to create barriers and hamper the aspirational potential of integrated care. To understand the potential for states to widely disseminate integrated care, we propose to study Washington State’s “Integrated Managed Care” (IMC) initiative. Under this initiative, Medicaid beneficiaries will receive comprehensive physical and mental health services through a single, integrated managed care plan. The implementation of IMC takes place in a staggered fashion over the 2016-2020 timespan, with counties assigned to one of five waves that must transition from the existing carve-out system to IMC. This natural experiment creates an opportunity for a robust quantitative and qualitative study of the effects of full (financial and service) integration of physical and mental health. Our proposal leverages Washington’s Integrated Client Database System, a unique resource linking Medicaid claims to rich measures of social determinants of health, including housing, employment, and contacts with the criminal justice system. The proposed research seeks to enhance our understanding of how states can advance the use of integrated care, including the factors that may facilitate or hinder integration, and whether full financial integration can affect resource use or impact social determinants of health. We seek to fill these gaps in knowledge with the hope of providing actionable information to Medicaid agencies and health systems across the U.S., addressing questions about the feasibility and benefits of financial integration, with specific information about carving in or carving out services, the factors that facilitate integration at the clinical level, and the ways in which social service needs among individuals with severe mental illness are affected. This work is closely aligned with NIMH’s Strategic Objective 4.1 to “improve the efficiency and effectiveness of existing mental health services,” which includes research to “optimize financing models for adults and children with serious mental illnesses to provide efficient and effective care in public and private health care systems.” The combination of a strong natural experiment, detailed contextual data, and a rich set of outcomes will allow us to develop rigorous and actionable evidence to guide the provision of mental health services in Medicaid.

项目概要 提供精神卫生服务的公共保险的设计是一个至关重要的政策问题。一个大 大量研究表明，综合护理模式对患者有很大好处，这使得 在同一环境中获得初级身心保健服务。然而，集成化技术的广泛采用 护理模式还没有出现。一个关键且持续的障碍是融资和支付的分离 身心健康服务，特别是以医疗补助中心理健康“排除”的形式 程序。人们认为，分割会造成障碍并阻碍综合护理的理想潜力。 为了了解各州广泛传播综合护理的潜力，我们建议研究华盛顿 州政府的“综合管理医疗”（IMC）计划。根据这一举措，医疗补助受益人将获得 通过单一、综合的管理式护理计划提供全面的身心健康服务。这 IMC 的实施在 2016 年至 2020 年期间以交错的方式进行，各县 分配给必须从现有剥离系统过渡到 IMC 的五波之一。这种自然的 实验为对全面（财务）​​影响进行强有力的定量和定性研究创造了机会 和服务）身心健康一体化。我们的提案利用了华盛顿的综合客户 数据库系统是一种独特的资源，将医疗补助索赔与健康社会决定因素的丰富衡量标准联系起来， 包括住房、就业以及与刑事司法系统的联系。 拟议的研究旨在增强我们对各国如何推进综合利用的理解 照顾，包括可能促进或阻碍融合的因素，以及全面的财务融合是否可以 影响资源利用或影响健康的社会决定因素。我们寻求填补这些知识空白 希望向美国各地的医疗补助机构和卫生系统提供可操作的信息，解决 有关金融一体化的可行性和好处的问题，以及有关融入或融入的具体信息 制定服务、促进临床层面整合的因素以及社会参与的方式 严重精神疾病患者的服务需求受到影响。这项工作与 NIMH 的战略目标 4.1 是“提高现有精神卫生服务的效率和有效性” 其中包括“优化患有严重精神疾病的成人和儿童的融资模式，以 在公共和私人医疗保健系统中提供高效和有效的护理。”强强联合 自然实验、详细的背景数据和丰富的结果将使我们能够开发出严格的、 指导在医疗补助中提供心理健康服务的可行证据。