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

描述（由申请人提供）：创新的俄勒冈健康计划（Medicaid）是全国医疗改革的领导者。州立法（在两党支持下通过）授权协调医疗组织（CCOs）管理医疗补助接受者的医疗服务。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/州示范赠款，用于改革医疗保健，医疗保险和医疗补助服务中心于2012年7月5日批准了俄勒冈健康计划中的变更。8个coo于2012年8月1日成立，另外6个于2012年9月1日成立。俄勒冈州是评估医疗改革对药物和酒精使用障碍治疗影响的理想场所。首席保健官将身体和行为保健整合到单一问责点（以患者为中心的初级保健之家），以增加获得保健的机会，控制医疗保健成本并改善健康结果。果断的预防和疾病管理服务力求减少不必要的急诊和住院护理。全球预算和共享储蓄促进了医疗质量。一个主要目标是通过与初级保健相结合，改善获得和利用治疗酒精和药物使用障碍的服务。该研究比较和对比了CCOs内成瘾治疗服务的整合。对整合和融资战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。俄勒冈州的所有付款人所有索赔（APAC）数据库提供了对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)接受艾滋病毒快速检测的患者数量的使用情况和许可计数的全面描述。此外，亚太地区的数据还记录了急诊和住院情况。这项研究有三个具体目的。具体目标1：第一年审查和编码批准的CCO申请，采访CCO利益相关者，评估a)行为健康整合策略，b)结果监测，c)行为医疗保健系统重新设计，并选择8个CCO在2至5年级进行深入研究；这8个研究地点为城市和农村社区提供服务，在整合和融资策略方面各不相同。具体目标2：从亚太地区数据中提取利用数据，并a)比较cco， b)跟踪研究措施（即筛查、咨询、药物使用障碍的药物治疗处方、艾滋病毒快速检测）和结果（即诊断为药物和酒精使用障碍的个人使用急诊和住院护理）的支出和利用变化，c)评估药物和酒精服务的支出和利用与急诊和住院护理的支出和比率之间的关系。具体目标3：完成一项综合定性（例如，关键信息者访谈、观察）和定量数据（利用率和支出）的混合方法评估，以确定在以患者为中心的初级保健家中与成瘾治疗服务使用相关的个人、组织和环境变量。

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.