The Impact of Health Care Reform on Addiction and HIV Services

卫生保健改革立法对获得服务和扩大保健服务具有重大影响。 对物质使用障碍（SUD）患者，特别是艾滋病毒感染者的益处。这些条件 与多种医学和精神病合并症以及高医疗保健费用相关。应对 RFA-DA-13-001，拟议的研究重点是平价医疗法案（ACA）的关键要素， 该计划将于2014年实施，并可能增加对SUD和艾滋病毒治疗服务的需求。该研究评估了 ACA对SUD患者在护理环境中的影响非常适合ACA实施研究。 Kaiser Permanente北方加州（KPNC）是一个大型医疗保健系统，提供综合SUD和 医疗，并已被指定为全州的基准，为小团体计划在加州 健康保险交易所我们的创新方法是由一个综合的概念模型， 组织理论和卫生服务利用。在这项分阶段研究中，R21阶段的目标是 分析会员人口统计学和临床复杂性、服务使用和 费用，使用新入组的患有SUD的ACA前健康计划成员队列（n=3641），包括成员 感染了SUD和HIV在R33阶段，我们使用前后设计将R21队列与第二个队列进行比较， 新入组的SUD KPNC成员的ACA后队列，使用高级差异中差异 分析ACA相关变化的方法，这些变化开始于2014年。主要成果包括成员变化， 卫生服务的利用和成本，SUD治疗的启动和保留，以及艾滋病毒管理。邮报- ACA队列也将在两年内进行纵向随访。通过创新的混合方法， 我们使用健康计划的数据广泛的电子病历，辅以定性访谈 与组织和临床负责人就ACA相关的福利计划、服务交付的变更进行沟通， 劳动力，以及影响ACA实施的障碍或促进因素。调查结果将提供大量信息， 了解健康计划如何实施ACA并为新投保的SUD和HIV患者提供服务 这将有助于未来的卫生政策。

Health care reform legislation has significant implications for access to services and expansion of benefits for those with substance use disorders (SUD), particularly those with HIV. These conditions are associated with multiple medical and psychiatric comorbidities as well as high health care costs. Responding to RFA-DA-13-001, the proposed study focuses on key elements of the Affordable Care Act (ACA) that will be implemented in 2014 and will likely increase demand for SUD and HIV treatment services. The study evaluates the impact of the ACA on individuals with SUDs in a care setting well-suited to ACA implementation research. Kaiser Permanente Northern California (KPNC) is a large health care system providing integrated SUD and medical treatment and has been designated as the statewide benchmark for small group plans in the California health insurance exchange. Our innovative approach is informed by an integrated conceptual model of organizational theory and health service utilization. In this phased study, the Aims of the R21 phase lay the groundwork for analyzing changes in membership demographics and clinical complexity, services use and costs, using a cohort (n=3641) of newly enrolled pre-ACA health plan members with SUDs, including members with both SUDs and HIV. In the R33 phase, we use a pre-post design to compare the R21 cohort to a second, post-ACA cohort of newly enrolled KPNC members with SUDs, using advanced difference-in-difference methods to analyze ACA-related changes that begin in 2014. Key outcomes include membership changes, health services utilization and costs, SUD treatment initiation and retention, and HIV management. The post- ACA cohort will also be followed longitudinally over two years. With an innovative mixed-methods approach, we use data from the health plans extensive electronic medical record, supplemented by qualitative interviews with organizational and clinical leaders regarding ACA-related changes to benefit plans, service delivery, workforce, and barriers or facilitators that impact ACA implementation. Findings will be highly informative in understanding how health plans implement the ACA and serve newly insured SUD and HIV patient populations, and will contribute to future health policy.