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覆盖范围将使更多人能够获得SUD治疗 那些目前没有保险的人。然而，各国将对费用控制感到关切，因为 覆盖范围的扩大将增加紧张预算的压力。健康之家(HHS)是联邦政府的 由《平价医疗法案》启动的资助医疗补助计划，旨在提高医疗质量并减少 对慢性医疗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 在医疗补助覆盖的最脆弱人群中。纽约(NY)已获得联邦政府的批准 目前正在全州范围内推出HH计划(预计注册人数约为75万人)。纽约卫生与公众服务部 该计划具有鲜明的特点，包括重点关注患有慢性医学和精神疾病的参与者中的SUD 健康障碍，促进不同类型提供者之间的当地伙伴关系，并利用护理管理人员 确保以病人为中心的护理。使用纵向设计，这项研究将检验NY HH计划 改善医疗质量，减少低效医疗保健，并降低12万/年个人的成本 有资格在纽约申请HHS的南德人。2006年至2016年的管理数据将来自 医疗补助申请和遭遇以及包括社会人口统计在内的南加州登记记录的组合 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 目标是通过与国家建立书面协议来建立研究基础设施 机构，创建分析数据集，并制定初始卫生保健参与者的统计描述。数据 分析将包括使用描述性和混合效应Logistic回归分析来描述和对比 亚组(例如，HH)的历史和基线社会人口、临床和医疗保健利用率 没有SUD的合格客户；有SUD的高风险客户)。在R33阶段(4年)，主要目标包括检查 HHS是否改善了SUD治疗的医疗补助质量指标、医疗和精神卫生保健的质量 在SUD客户中，提高医疗保健效率(例如，可以避免再次住院)，以及减少医疗补助 成本。混合效应Logistic回归模型将检验护理质量历史比率的变化 指标和成本，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按年检查医疗补助成本。次要目标侧重于 为HHS对结果的影响做出因果推断提供了进一步的证据。回归 分析将通过比较参与者和 统计匹配的非参保者，检查护理经理活动和结果之间的关联， 主持人(例如，无家可归)和调解人(例如，初级保健参与度)之间的关联 效率和成本并重。随着其他州扩大医疗补助的覆盖范围和使用，这些发现将具有相关性 针对慢性病的类似改革努力针对最昂贵和最有需要的人群。

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.