The Impact of Health Care Reform on Addiction and HIV Services

医疗改革立法对获得服务和扩大 对物质使用障碍(SUD)患者，特别是艾滋病毒携带者的好处。这些条件是 与多种医疗和精神合并症以及高昂的医疗费用有关。回应 RFA-DA-13-001，拟议的研究重点是平价医疗法案(ACA)的关键要素，这些要素将是 2014年开始实施，可能会增加对严重急性呼吸综合征和艾滋病毒治疗服务的需求。这项研究评估 ACA对处于非常适合ACA实施研究的护理环境中的SODS患者的影响。 Kaiser Permanente North California(KPNC)是一个大型医疗保健系统，提供集成的SUD和 医疗，并已被指定为加州小团体计划的全州基准 健康保险交易所。我们的创新方法是由一个完整的概念模型 组织理论与卫生服务利用。在这项阶段性研究中，R21阶段的目标是 为分析成员人口统计和临床复杂性、服务使用和 费用，使用新登记的具有SODS的ACA前健康计划成员队列(n=3641)，包括成员 既有肥皂水又有艾滋病毒。在R33阶段，我们使用前置后设计来比较R21队列和第二个队列， ACA后新登记的KPNC成员使用SUDS，使用高级差异 分析2014年开始的ACA相关变化的方法。主要结果包括成员资格的改变， 卫生服务利用和费用、sud治疗的启动和保留以及艾滋病毒管理。邮报- ACA的队列还将在两年多的时间里进行纵向跟踪。通过创新的混合方法， 我们使用的数据来自健康计划广泛的电子病历，并辅之以定性访谈 与组织和临床领导者讨论与ACA相关的福利计划、服务交付、 劳动力，以及影响ACA实施的障碍或促进者。调查结果将在 了解健康计划如何实施ACA并为新参保的SUD和HIV患者提供服务 并将对未来的卫生政策作出贡献。

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.