The Effects of Statewide Comprehensive Integrated Care for Medicaid Enrollees.

项目总结 公共保险在提供精神卫生服务中的设计是一个至关重要的政策问题。大号 许多研究表明，综合护理模式对患者有实质性的好处，这种模式允许 在一个环境中获得初级身心健康保健。然而，广泛采用集成 护理模式尚未出现。一个关键的和持续的障碍是资金和付款的分离 身心健康服务，特别是在医疗补助中以精神健康“创业”的形式 程序。分拆被认为制造了障碍，阻碍了综合护理的抱负潜力。 为了了解各州广泛传播综合保健的潜力，我们建议研究华盛顿 国家的“综合管理医疗”(IMC)倡议。根据这一计划，医疗补助受益人将获得 通过单一的综合管理保健计划提供全面的身心健康服务。这个 在2016-2020年的时间跨度内，以交错的方式实施IMC，各县 被分配到必须从现有的创业体系过渡到IMC的五个浪潮之一。这很自然 实验为对FULL(金融)的影响进行强有力的定量和定性研究创造了机会 和服务)身心健康相结合。我们的方案利用了华盛顿的综合客户 数据库系统，这是一个独特的资源，将医疗补助声称与健康的社会决定因素的丰富指标联系起来， 包括住房、就业和与刑事司法系统的联系。 这项拟议的研究旨在加强我们对各州如何促进综合技术的使用的理解 关注，包括可能促进或阻碍一体化的因素，以及全面金融一体化是否能够 影响资源使用或影响健康的社会决定因素。我们试图用这些知识来填补这些空白 希望向美国各地的医疗补助机构和卫生系统提供可行的信息，解决 关于金融整合的可行性和好处的问题，以及关于在或 开拓服务，促进临床层面的整合的因素，以及社会 严重精神病患者的服务需求受到影响。这项工作与 NIMH的战略目标4.1“提高现有精神健康服务的效率和效力”， 其中包括研究“优化成人和患有严重精神疾病的儿童的融资模式，以 在公共和私人卫生保健系统中提供高效和有效的护理。一个强大的组合 自然的实验、详细的背景数据和丰富的结果集将使我们能够开发出严谨和 指导医疗补助中提供精神健康服务的可操作证据。

PROJECT SUMMARY The design of public insurance in providing mental health services is a critically important policy issue. A large number of studies have demonstrated substantial benefits for patients in integrated care models, which allow access to primary physical and mental health care in one setting. However, widespread adoption of integrated care models has not occurred. A critical and continuing barrier is the separation of financing and payment for physical and mental health services, particularly in the form of mental health “carve-outs” in Medicaid programs. Carve-outs are perceived to create barriers and hamper the aspirational potential of integrated care. To understand the potential for states to widely disseminate integrated care, we propose to study Washington State’s “Integrated Managed Care” (IMC) initiative. Under this initiative, Medicaid beneficiaries will receive comprehensive physical and mental health services through a single, integrated managed care plan. The implementation of IMC takes place in a staggered fashion over the 2016-2020 timespan, with counties assigned to one of five waves that must transition from the existing carve-out system to IMC. This natural experiment creates an opportunity for a robust quantitative and qualitative study of the effects of full (financial and service) integration of physical and mental health. Our proposal leverages Washington’s Integrated Client Database System, a unique resource linking Medicaid claims to rich measures of social determinants of health, including housing, employment, and contacts with the criminal justice system. The proposed research seeks to enhance our understanding of how states can advance the use of integrated care, including the factors that may facilitate or hinder integration, and whether full financial integration can affect resource use or impact social determinants of health. We seek to fill these gaps in knowledge with the hope of providing actionable information to Medicaid agencies and health systems across the U.S., addressing questions about the feasibility and benefits of financial integration, with specific information about carving in or carving out services, the factors that facilitate integration at the clinical level, and the ways in which social service needs among individuals with severe mental illness are affected. This work is closely aligned with NIMH’s Strategic Objective 4.1 to “improve the efficiency and effectiveness of existing mental health services,” which includes research to “optimize financing models for adults and children with serious mental illnesses to provide efficient and effective care in public and private health care systems.” The combination of a strong natural experiment, detailed contextual data, and a rich set of outcomes will allow us to develop rigorous and actionable evidence to guide the provision of mental health services in Medicaid.