Oregon's Coordinated Care Organizations Integrate Care for Drug Use Disorders

描述(由申请人提供)：创新的俄勒冈州健康计划(医疗补助)是全国医疗改革的领导者。州立法(在两党支持下通过)授权协调护理组织(CCO)管理对医疗补助接受者的护理。2012年5月，俄勒冈州获得了一笔为期5年的19亿美元的联邦/州示范拨款，用于改造医疗保健，联邦医疗保险和医疗补助服务中心于2012年7月5日批准了俄勒冈州健康计划的变化。8名CCOS于2012年8月1日开始，另外6名CCOS于2012年9月1日开始。俄勒冈州是评估医疗改革对药物和酒精使用障碍治疗的影响的理想环境。CCO在单一责任点(以患者为中心的初级疗养院)中集成了身体和行为健康护理，以增加获得护理的机会、控制医疗成本并改善健康结果。果断的预防和疾病管理服务寻求减少不必要的紧急护理和医院护理。全球预算和共享储蓄提高了医疗质量。一个主要目标是通过与初级保健相结合，改善酒精和药物使用障碍服务的获得和利用。这项研究比较和对比了CCOS内成瘾治疗服务的整合情况。对整合和融资策略的变化进行了描述和编码，以评估与医疗保健利用的关联。俄勒冈州的All Payer All Claims(APAC)数据库提供了a)筛查、b)咨询、c)酒精或阿片类药物使用障碍处方药以及d)艾滋病毒快速检测检测的患者数量和使用情况的全面描述。此外，亚太地区的数据还记录了急诊和住院人数。这项研究有三个具体目标。具体目标1：第1年-审查批准的CCO申请并编写代码，采访CCO利益相关者以评估a)行为健康整合战略、b)结果监测和c)行为健康系统重新设计，并选择8个CCO在第2年至第5年进行强化研究；8个研究地点服务于城市和农村社区，并在整合和融资策略上有所不同。具体目标2：从亚太地区的数据中提取利用数据，并a)比较CCOS，b)跟踪研究措施(即筛查、咨询、药物治疗药物使用障碍处方、艾滋病毒快速检测)和结果(即，在被诊断为药物和酒精使用障碍的个人中使用急诊和住院护理)的支出和利用的变化，以及c)评估药物和酒精服务支出和利用与急诊和住院护理支出和比率之间的关系。具体目标3：完成一项混合方法评估，将定性数据(例如，关键的告密者访谈、观察)和定量数据(使用率和支出)相结合，以确定与以患者为中心的初级疗养院使用成瘾治疗服务相关的个人、组织和背景变量。

DESCRIPTION (provided by applicant): The innovative Oregon Health Plan (Medicaid) is a national leader in healthcare reform. State legislation (passed with bipartisan support) authorized Coordinated Care Organizations (CCOs) to manage care for Medicaid recipients. In May 2012, Oregon received a five year $1.9 billion federal/state demonstration grant to transform care and the Centers for Medicare and Medicaid Services approved the changes in the Oregon Health Plan July 5, 2012. Eight CCOs began August 1, 2012 and six more September 1, 2012. Oregon is an ideal setting to assess the impact of healthcare reform on treatment for drug and alcohol use disorders. CCOs integrate physical and behavioral health care in a single point of accountability (a patient centered primary care home) to increase access to care, control healthcare costs and improve health outcomes. Assertive preventive and disease management services seek to reduce unnecessary emergency and hospital care. Global budgets and shared savings promote quality of care. A major goal is to improve access to and utilization of services for alcohol and drug use disorders through integration with primary care. The study compares and contrasts the integration of addiction treatment services within CCOs. Variations in integration and financing strategies are described and coded to assess associations with healthcare utilization. Oregon's All Payer All Claims (APAC) database provides a comprehensive description of utilization and permits counts of the numbers of patients a) screened, b) counseled, c) prescribed medications for alcohol or opioid use disorders, and d) tested with HIV rapid testing. The APAC data, moreover, record emergency visits and inpatient admissions. The study has three specific aims. Specific Aim 1: Year 1-review and code approved CCO applications, interview CCO stakeholders to assess a) behavioral health integration strategies, b) outcomes monitoring, and c) system redesign for behavioral healthcare, and select eight CCOs for intensive study during Years 2 through 5; the 8 study sites serve urban and rural communities and vary in integration and financing strategies. Specific Aim 2: Extract utilization data from the APAC data and a) compare CCOs, b) track change in spending and utilization on study measures (i.e., screening, counseling, pharmacotherapy prescriptions for substance use disorders, HIV rapid testing), and outcomes (i.e., use of emergency and inpatient care among individuals with diagnoses of drug and alcohol use disorders), and c) assess relationships between spending on and utilization of drug and alcohol services and expenditures for and rates of emergency and inpatient care. Specific Aim 3: Complete a mixed methods assessment integrating qualitative (e.g., key informant interviews, observations) and quantitative data (utilization rates and expenditures) to identify individual, organizational, and contextual variables associated with use of addiction treatment services in patient centered primary care homes.