The Impact of Health Homes in New York State on People with Substance Use Disorde

通过医疗补助扩大医疗保险范围将使更多的人获得SUD治疗， 那些目前没有保险的人。然而，各国将担心成本控制， 扩大覆盖面将增加紧张预算的压力。健康之家（Health Homes，HHS）是一个联邦机构。 资助的医疗补助计划根据《平价医疗法案》提高护理质量， 慢性病和行为疾病的浪费性支出。HHS旨在增加以患者为中心的护理 在医疗补助计划覆盖的最脆弱人群中。纽约（NY）已获得联邦批准 目前正在全州范围内推出HH计划（预计入学人数约为75万人）。纽约HHS 该计划具有鲜明的特点，包括关注慢性医疗和精神疾病的注册者中的SUD 健康障碍，促进不同类型的提供者之间的地方伙伴关系，并利用护理管理人员， 确保以病人为中心的护理。采用纵向设计，本研究将探讨纽约HH计划是否 提高护理质量，减少低效的医疗保健，并降低每年120，000人的成本 有资格在纽约申请HHS的SUD。2006年至2016年的行政数据将来自一个 医疗补助索赔和遭遇以及SUD州登记记录（包括社会人口统计数据）的组合 和物质使用数据。研究将分两个阶段进行。在R21阶段（1年），主要 目的是通过与国家签订书面协议，建立研究基础设施 机构，创建分析数据集，并开发初始HH注册者的统计描述。数据 分析将包括使用描述性和混合效应逻辑回归分析来描述和对比 亚组之间的历史和基线社会人口统计学、临床和医疗保健利用（例如，HH 无SUD的合格客户;有SUD的高风险客户）。在R33阶段（4年），主要目的包括检查 HHS是否改善SUD治疗的医疗补助质量指标，医疗和精神卫生保健质量 在SUD客户中，医疗保健的效率（例如，可避免的再住院），以及减少医疗补助 成本混合效应逻辑回归模型将检查护理质量历史比率的变化 度量和成本同时控制各种因素（例如，个别临床复杂因素）。 广义伽马模型将用于检查医疗补助费用按年。次要目标： 为HHS对结果的影响的因果推断提供了进一步的证据。回归 分析将探索HH计划与质量和成本之间的关系， 统计学上匹配的非登记者，检查护理经理活动和结果之间的关联， 以及主持人之间的关联（例如，无家可归者）和调解员（例如，初级保健参与） 效率和成本。随着其他州扩大医疗补助的覆盖范围和使用，调查结果将具有相关性 针对费用最高和最需要帮助的人群开展类似的慢性病改革工作。

The expansion of healthcare coverage through Medicaid will allow greater access to SUD treatment among those who currently do not have coverage. However, States will be concerned about cost containment as expansion of coverage will increase pressures on strained budgets. Health Homes (HHs) are a federally funded Medicaid programauthorized by the Affordable Care Actto improve quality of care and reduce wasteful spending for chronic medical and behavioral conditions. HHs aim to increase patient centered care among the most vulnerable populations covered under Medicaid. New York (NY) has received federal approval and is currently rolling out its HH program statewide (anticipated enrollment of about 750,000). The NY HHs program has distinct features including a focus on SUD among enrollees with chronic medical and mental health disorders, fostering of local partnerships among diverse types of providers, and use of care managers to ensure patient centered care. Using a longitudinal design, this study will examine whether the NY HH program improves quality of care, reduces inefficient healthcare, and lowers costs among the 120,000/year individuals with SUD who are eligible for HHs in NY. Administrative data from 2006 through 2016 will be derived from a combination of Medicaid claims and encounters and SUD state registry records which include sociodemographics and substance use data. The study will occur in two phases. In the R21 Phase (1 Year), Primary Aims focus on putting a research infrastructure in place by establishing written agreements with state agencies, creating analytical datasets, and developing a statistical description of initial HH enrollees. Data analysis will include using descriptive and mixed effects logistic regression analyses to describe and contrast historical and baseline socio-demographic, clinical and healthcare utilization among subgroups (e.g., HH eligible with no SUD; high risk clients with SUD). In the R33 Phase (4 years), Primary Aims include examining whether HHs improve Medicaid quality indicators of SUD treatment, quality of medical and mental health care among SUD clients, efficiency of healthcare (e.g., avoidable rehospitalizations), as well as reduce Medicaid costs. Mixed effects logistic regression models will examine changes from historical rates of quality of care metrics and of costs while controlling for a variety of factors (e.g., individual clinically complicating factors). Generalized gamma models will be used to examine Medicaid costs by year. Secondary Aims focus on providing further evidence for making causal inferences about the effect of HHs on outcomes. Regression analyses will explore the relationship between HH program and quality and costs by comparing enrollees to statistically matched non-enrollees, examining the association between care manager activity and outcomes, and the association between moderators (e.g., homelessness) and mediators (e.g., primary care engagement) with efficiency and costs. Findings will have relevance as other states expand Medicaid coverage and use similar reform efforts for chronic conditions targeting the costliest and neediest populations.