Effects of Medicaid Managed Care on Medication Assisted Treatment Use and Health Outcomes among Pregnant Women with Opioid Use Disorder

医疗补助管理式护理对阿片类药物使用障碍孕妇的药物辅助治疗使用和健康结果的影响

• 批准号: 10517956
• 负责人: Samantha Auty
• 金额: $ 4.22万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10517956
• 关键词: Effects; Medicaid; Managed; Care; Medication

PROJECT SUMMARY Pregnant women with opioid use disorder (OUD) are at high risk of potentially avoidable morbidity and mortality. Since 2000, this population has experienced large increases in maternal mortality, largely driven by rising rates of drug overdose. Use of medications for opioid use disorder (MOUD) reduces the risk of poor maternal health outcomes, but pregnant women with OUD infrequently access them. More than 80% of pregnant women with OUD are enrolled in Medicaid and eligible to access MOUD throughout pregnancy, but the structure of state Medicaid programs may deter use of these lifesaving medications. Medicaid managed care (MMC) organizations are the dominant vehicle for delivering coverage to enrollees, but often impose more restrictions to access to MOUD than Medicaid fee-for-service (FFS). Several states have implemented uniform preferred drug lists (PDL) to reduce variation in coverage between Medicaid FFS and MMC, but the impact of this policy on MOUD use is unknown. Given that FFS coverage of MOUD is often more generous, uniform PDLs may improve access to MOUD by standardizing the drugs that MMC organizations must cover to a state-wide benchmark. However, the impact of uniform PDLs on MOUD use is unknown, and no prior research has assessed the broader impact of MMC enrollment on maternal health outcomes among pregnant women with OUD. The long-term goal of this work is to identify Medicaid policies that improve the health of pregnant women with OUD. In pursuit of this goal, the specific aims of this proposal are to: (1) Evaluate differences in MOUD use and severe maternal morbidity among pregnant women with OUD enrolled in Medicaid FFS vs. MMC, and if there are any differences in these outcomes by race/ethnicity (2) Determine if MOUD use changes after adoption of uniform PDLs between Medicaid FFS and MMC, and (3) Assess if MMC enrollment increases the rate of severe maternal morbidity among pregnant women with OUD compared to FFS enrollment. Building on the findings from Aim 1, a study examining the national association of MMC with aforementioned outcomes, we will employ quasi-experimental approaches in Aims 2-3 to examine the impact of MMC on MOUD use and severe maternal morbidity in states exposed to temporal and geographic policy variation. This work is innovative because it uses national Medicaid claims data to examine MOUD use and severe maternal morbidity, which is more reliable than survey data and more comprehensive than claims from a single state. This proposal is significant because it focuses on how MMC may adversely impact the health of pregnant women with OUD, which has not been considered by prior research. This proposal responds to the Special Emphasis Notice focused on the substance use disorder crisis in the United States (SEN NOT-HS-21-010). This research will identify the effects of MMC enrollment and policies on MOUD use and severe maternal morbidity among pregnant women with OUD, which may provide evidence to states newly- implementing MMC who are well-positioned to design policies that promote the health of this high-risk population. 1

项目摘要 患有阿片类药物使用障碍（OUD）的孕妇面临着潜在可避免的发病风险， mortality.自2000年以来，这一人口的孕产妇死亡率大幅上升，主要是由于 药物过量的比率。使用阿片类药物使用障碍（MOUD）药物可降低孕产妇健康不良的风险 结果，但患有OUD的孕妇很少获得它们。超过80%的孕妇患有OUD 参加了医疗补助计划，并有资格在整个怀孕期间获得MOUD，但州医疗补助计划的结构 项目可能会阻止使用这些救命药物。医疗补助管理式护理（MMC）组织是 主要的车辆提供覆盖登记，但往往施加更多的限制，以获得MOUD比 医疗补助按服务收费（FFS）。几个州已经实施了统一的首选药物清单（PDL），以减少 Medicaid FFS和MMC之间的覆盖范围存在差异，但该政策对MOUD使用的影响尚不清楚。 考虑到MOUD的FFS覆盖范围通常更广泛，统一的PDL可以通过以下方式改善MOUD的访问 将MMC组织必须覆盖的药物标准化为全州范围的基准。然而， 统一的PDL对MOUD使用的影响尚不清楚，之前也没有研究评估MMC的更广泛影响 OUD孕妇的孕产妇健康结局。 这项工作的长期目标是确定改善孕妇健康的医疗补助政策 关于OUD为了实现这一目标，本提案的具体目标是：（1）评估MOUD使用的差异， 参加Medicaid FFS与MMC的OUD孕妇中的重度孕产妇发病率，如果有 这些结果的任何差异（2）确定采用统一的MOUD后，MOUD的使用是否发生变化 Medicaid FFS和MMC之间的PDL，以及（3）评估MMC登记是否会增加重度孕产妇死亡率 OUD孕妇的发病率与FFS入组相比。根据目标1的调查结果，a 一项研究检查MMC与上述结果的国家关联，我们将采用准实验 目标2-3中的方法，以检查MMC对各州MOUD使用和严重孕产妇发病率的影响 受时间和地理政策变化的影响。这项工作是创新的，因为它使用国家医疗补助计划 声称数据检查MOUD的使用和严重的孕产妇发病率，这比调查数据更可靠， 比一个国家的要求更全面。这一建议意义重大，因为它侧重于MMC如何 对患有OUD的孕妇的健康产生不利影响，这一点尚未被之前的研究考虑到。这 该提案是对美国物质使用障碍危机的特别强调通知的回应 (SEN NOT-HS-21-010）。这项研究将确定MMC注册和政策对MOUD使用的影响， OUD孕妇的严重孕产妇发病率，这可能为各州提供新的证据- 实施MMC的人有能力设计促进这一高风险人群健康的政策。 1