Alternative payment models and alcohol use disorder treatment and consequences

替代支付模式和酒精使用障碍治疗及后果

• 批准号: 10642757
• 负责人: Susan H Busch
• 金额: $ 57.8万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10642757
• 关键词: Acute; Adult; Award; Black race; COVID-19; Caring; Certification; Chronic; Clinic; Clinical; Communities; Complex; Cost Savings; County; Crime; Data; Evidence based treatment; Grant; Health; Health Services; Health system; Hispanic; Improve Access; Incentives; Individual; Information Systems; Infrastructure; Interdisciplinary Health Team; Investments; Low income; Medicaid; Medical; Mental Health; Methodology; Modeling; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Performance; Physicians; Policies; Primary Care; Prospective Payment System; Provider; Public Health; Quasi-experiment; Recovery; Reimbursement Mechanisms; Reporting; Research; Research Personnel; Resources; Savings; Services; Substance Use Disorder; Surgeon; System; Telemedicine; Traffic accidents; Training; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; addiction; alcohol involvement; alcohol use disorder; behavioral health; black patient; cost; design; evidence base; flexibility; health disparity populations; improved; information technology workforce; interest; intimate partner violence; medical specialties; neighborhood disadvantage; pandemic disease; payment; policy implication; preventable death; programs; public health emergency; screening; service delivery; societal costs; treatment and outcome; treatment services; vehicular accident

PROJECT SUMMARY Alcohol Use Disorder (AUD) is one of the leading causes of preventable death in the US and has high personal and societal costs. Despite the widespread acceptance that evidence-based treatments exist for AUD, less than one in nine individuals with AUD report receiving specialty treatment. Challenges are particularly acute in disadvantaged communities. Only 60 percent of US counties have a specialty substance use disorder (SUD) treatment clinic that accepts Medicaid, despite Medicaid being the largest payer of addiction treatment services in the US. In 2017, The Centers for Medicare and Medicaid Services initiated the Certified Community Behavioral Health Clinic (CCBHC) demonstration, a program designed to increase access and the receipt of evidence-based care in Medicaid in eight states. As a part of this initiative, CCBHCs were required to provide nine services chosen to improve access; to provide data on quality metrics; and to engage in a prospective payment system. Since the initial 66-clinic demonstration, the CCBHC program has expanded to over 240 clinics in 40 states; A primary distinction between the initial demonstration and the expanded model is that in the expanded model clinics retain traditional reimbursement mechanisms but are awarded a large annual grant (~$2 million). We use a quasi-experimental approach to compare changes in the receipt of AUD services before and after CCBHC program implementation with changes in the receipt of AUD services in a set of matched comparison clinics (or counties). Our project brings together an interdisciplinary team of health services researchers, physicians, and economists with the methodological and substantive expertise to examine this understudied issue and explore its complex public health, clinical, and policy implications. Our specific aims are to assess whether CCBHC implementation was associated with: 1a) Changes in AUD identification and treatment quality; 1b) Differential changes in AUD identification and treatment quality in demonstration versus expansion clinics; 2) Differential changes in AUD treatment receipt and quality during the COVID-19 public health emergency in CCBHC compared to non-CCBHC clinics; and 3) Changes in trajectories of public health outcomes, including county-level reports of crime and alcohol-involved fatal motor vehicle accidents. This grant is responsive to NOT-AA-20-022, “Notice of Special Interest: Advances in Research for the Treatment, Services, and Recovery of Alcohol Use Disorder” and will provide information ‘to bridge the gap between those who need treatment and those who receive treatment.’ In addition, we focus on the Medicaid program, which disproportionately serves NIH-designated US health disparity populations. The significance of this study lies in its focus on how to optimize delivery systems to improve treatment and outcomes associated with AUD, a growing challenge and understudied policy issue.

项目摘要 酒精使用障碍（AUD）是美国可预防死亡的主要原因之一， 和社会成本。尽管广泛接受AUD存在循证治疗，但 超过九分之一的AUD患者报告接受专业治疗。在以下方面，挑战尤为严峻： 弱势群体。只有60%的美国县有特殊物质使用障碍（SUD） 接受医疗补助的治疗诊所，尽管医疗补助是成瘾治疗服务的最大支付者 在美国. 2017年，医疗保险和医疗补助服务中心发起了认证社区 行为健康诊所（CCBHC）示范，一个旨在增加获得和接受 在八个州的医疗补助中进行循证护理。作为这一举措的一部分，CCBHC被要求提供 选择了九项服务，以改善获得服务的机会;提供质量指标数据;并参与前瞻性的 支付系统.自最初的66个诊所示范以来，CCBHC计划已扩展到240多个 40个州的诊所;初始示范和扩展模型之间的主要区别是， 扩大后的示范诊所保留了传统的报销机制，但每年可获得大笔赠款 （约200万美元）。我们使用准实验方法来比较AUD服务接收的变化 在CCBHC计划实施之前和之后， 匹配的比较诊所（或县）。我们的项目汇集了一个跨学科的健康团队， 服务研究人员，医生和经济学家与方法和实质性的专业知识， 研究这一未充分研究的问题，并探讨其复杂的公共卫生，临床和政策的影响。我们 具体目标是评估CCBHC的实施是否与以下因素相关：1a）澳元的变化 1b）AUD识别和治疗质量的差异变化， 示范诊所与扩展诊所; 2）在试验期间AUD治疗接收和质量的差异变化 CCBHC与非CCBHC诊所相比的COVID-19公共卫生紧急情况;以及3） 公共卫生结果的轨迹，包括县级犯罪和酒精相关致命运动的报告 车辆事故。此补助金是响应NOT-AA-20-022，“特别利益的通知： 酒精使用障碍的治疗、服务和康复研究”，并将提供 信息“以弥合需要治疗的人和接受治疗的人之间的差距。”在 此外，我们关注医疗补助计划，该计划不成比例地服务于NIH指定的美国健康 人口差距。这项研究的意义在于它的重点是如何优化输送系统， 改善与AUD相关的治疗和结局，这是一个日益严峻的挑战和未充分研究的政策问题。