Substance Use Disorder Treatment under New Payment and Delivery System Models

新支付和交付系统模式下的药物使用障碍治疗

• 批准号: 8668919
• 负责人: Colleen L Barry
• 金额: $ 71.72万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8668919
• 关键词: Address; Affect; Alcohol abuse; Alcohol or Other Drugs use; Ambulatory Care; Biological Models; Blue Cross; Blue Shield; Caring; Clinical; Commercial Sectors; Contracts; Country; Data; Dependence; Detection; Drug abuse; Enrollment; Fee-for-Service Plans; Fees; Goals; Growth; Health Care Sector; Health Personnel; Health Services; Healthcare; Incentives; Individual; Investigation; Lead; Leadership; Massachusetts; Measures; Medical; Metric; Modeling; Nicotine Dependence; Patients; Pattern; Perception; Performance; Phase; Plague; Population; Price; Primary Health Care; Provider; Public Sector; Qualitative Methods; Quality of Care; Reporting; Research; Resources; Rest; Risk; Services; Site Visit; Substance Use Disorder; System; Treatment Cost; base; care delivery; cost; disorder risk; flexibility; group intervention; improved; innovation; interest; medical specialties; payment; prospective; public health relevance; screening

DESCRIPTION (provided by applicant): There is broad national interest among commercial and public sector health care payers in new models of paying for and delivering health care services in an effort to control health care spending growth and to improve the efficiency, coordination, and quality of care. In 2009, Blue Cross Blue Shield of Massachusetts (BCBSMA) established the Alternative Quality Contract (AQC), which pays provider organizations a global payment with performance incentives in a way that resembles accountable care organization (ACO) models authorized under the Affordable Care Act. Research indicates that the AQC was associated with lower total health care spending and improved quality of care in its initial year o implementation. No information is available on how this type of model affects care for substance use disorders (SUD), defined as illicit drug and alcohol abuse and dependence, conditions plagued by system fragmentation and characterized by low rates of detection and treatment in primary care. Only a subset of AQC organizations accepted risk for SUD treatment costs, and the AQC's effects may differ based on inclusion of SUD risk in the contract. We will contrast the effects of AQC implementation for SUD with effects for nicotine dependence, a condition not subject to the same system fragmentation as SUD but which also has low rates of detection and treatment in primary care. Using BCBSMA claims and membership data for 2006-2011 to conduct difference- in-differences (DD) analyses comparing enrollees in two intervention groups - those in AQC organizations that did and did not accept SUD risk - with enrollees not participating in the AQC, we will examine the AQC's effects on: 1) use and price of SUD and nicotine dependence services; 2) spending on SUD and nicotine dependence services; and 3) HEDIS-based performance measures for SUD treatment. We will also use qualitative methods to explore perceptions about how the AQC affects use, price, spending, and quality of SUD and nicotine dependence services among administrative and clinical leadership of BCBSMA, AQC organizations, and specialty SUD treatment facilities. Only a handful of payment and delivery system models have been implemented around the country to achieve the goals of accountable care. This study can produce critical new information about whether global payment and accountable care reduce rates of SUD under- treatment, and improve the coordination and quality of SUD care without exacerbating incentives to avoid treating this population.

描述(由申请人提供)：商业和公共部门医疗保健付款人对支付和提供医疗保健服务的新模式具有广泛的国家利益，以努力控制医疗保健支出增长，提高医疗保健的效率、协调性和质量。2009年，马萨诸塞州蓝十字蓝盾(BCBSMA)建立了替代质量合同(AQC)，以类似于根据《合理医疗费用法案》授权的责任护理组织(ACO)模式的方式，向提供商组织支付具有绩效激励的全球付款。研究表明，在实施AQC的最初一年，AQC与较低的医疗总支出和改善的医疗质量有关。没有关于这种模式如何影响药物使用障碍(SUD)护理的信息，物质使用障碍被定义为非法药物和酒精滥用和依赖，这些疾病受到系统支离破碎的困扰，其特点是初级保健的发现率和治疗率较低。只有少数AQC组织接受SUD治疗费用的风险，根据合同中是否包含SUD风险，AQC的影响可能有所不同。我们将比较对SUD实施AQC的效果与对尼古丁依赖的效果，尼古丁依赖的情况不会受到与SUD相同的系统碎片化的影响，但在初级保健中的发现和治疗率也很低。利用2006-2011年BCBSMA的声明和成员数据进行差异(DD)分析，比较两个干预组(接受和不接受SUD风险的AQC组织)的参与者和没有参与AQC的参与者，我们将检查AQC对以下方面的影响：1)SUD和尼古丁依赖服务的使用和价格；2)SUD和尼古丁依赖服务的支出；以及3)基于HEDIS的SUD治疗绩效衡量。我们还将使用定性方法来探索AQC如何影响BCBSMA、AQC组织和专业SUD治疗机构的行政和临床领导对SUD和尼古丁依赖服务的使用、价格、支出和质量的看法。在全国范围内，只有少数几种支付和交付系统模式被实施，以实现负责任的护理目标。这项研究可以提供关键的新信息，即全球支付和负责任的护理是否降低了SUD欠治愈率，并在不加剧避免治疗这一人群的激励的情况下改善了SUD护理的协调和质量。