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.

项目总结 酒精使用障碍(AUD)是美国可预防死亡的主要原因之一，在美国有很高的个人死亡率 以及社会成本。尽管人们普遍接受以循证为基础的治疗方法来治疗澳门氏症，但很少有 据报道，每九名澳门氏症患者中就有一人接受特殊治疗。挑战在以下方面尤为严峻 弱势群体。美国只有60%的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付款人 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)演示，该计划旨在增加访问和接收 八个州的医疗补助中的循证护理。作为这项倡议的一部分，CCBHC被要求提供 选择九项服务来改善访问；提供有关质量指标的数据；以及参与 支付系统。自最初的66个诊所示范以来，CCBHC计划已扩大到240多个 40个州的诊所；初始演示和扩展模型之间的主要区别是 扩大后的模式诊所保留了传统的报销机制，但每年获得一大笔赠款 (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 CCBHC计划实施前后随接收AUD服务变化的一套 匹配的对照诊所(或县)。我们的项目汇集了一个跨学科的健康团队 具有方法论和实质性专业知识的服务研究人员、医生和经济学家 研究这一未得到充分研究的问题，并探索其复杂的公共卫生、临床和政策影响。我们的 具体目标是评估CCBHC的实施是否与：1)澳元的变化 鉴定和治疗质量；1b)AUD鉴定和治疗质量的不同变化 示范与推广诊所；2)AUD治疗收治和质量在 新冠肺炎突发公共卫生事件在社区卫生服务中心与非社区卫生服务中心诊所的比较；以及3)变化 公共卫生结果的轨迹，包括县级犯罪和涉及酒精的致命运动的报告 车祸。这笔赠款是对NOT-AA-20-022《特别利益通知：垫款》的回应 酒精使用障碍的治疗、服务和康复研究“，并将提供 信息是为了弥合需要治疗的人和接受治疗的人之间的差距。在……里面 此外，我们专注于医疗补助计划，该计划不成比例地服务于NIH指定的美国健康 不平等的人口。这项研究的意义在于它的重点是如何优化递送系统以 改善与澳元病相关的治疗和结果，这是一个日益严峻的挑战，也是一个未得到充分研究的政策问题。