Can Medicaid Managed Care mitigate race/ethnic health disparities in diabetes?

医疗补助管理式医疗能否减轻糖尿病中的种​​族/民族健康差异？

• 批准号: 10709582
• 负责人: Mohammed Kumail Ali
• 金额: $ 48.92万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709582
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Adult; Affect; Age; American; Amputation; Behavior; Black race; COVID-19; COVID-19 pandemic; Caring; Categories; Characteristics; Chronic Disease; Classification; Communities; Contracts; Data; Data Analyses; Data Set; Databases; Diabetes Mellitus; Diagnosis; Disparity; District of Columbia; Economic Burden; Elderly; Eligibility Determination; Emergency department visit; Enrollment; Ethnic Origin; Expenditure; Florida; Future; Goals; Health; Healthcare; Heterogeneity; Hospitalization; Hyperglycemia; Incentives; Indigenous; Information Systems; Insurance Carriers; Interview; Investigation; Investments; Kentucky; Latinx; Lawyers; Link; Managed Care; Managed Care Programs; Marketing; Medicaid; Medicare/Medicaid; Methods; Minority; National Institute on Minority Health and Health Disparities; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Occupations; Outcome; Patients; Penetration; Performance; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Population; Poverty; Preventive care; Primary Care; Privatization; Process; Quality of Care; Race; Recommendation; Research; Risk; Sampling; Selection Bias; Services; Shock; Testing; Time; Titrations; Variant; Vulnerable Populations; Work; beneficiary; black patient; burden of illness; cohort; comorbidity; coronavirus disease; cost; data modeling; design; disenfranchised population; disparity reduction; ethnic disparity; ethnic health disparity; ethnic minority; evidence base; experience; family burden; foot; health disparity; high risk; improved; insight; marginalization; medical specialties; member; pandemic disease; pandemic impact; people of color; post-COVID-19; programs; racial disparity; racial health disparity; racial minority; response; service utilization; sex; socioeconomic disadvantage; trend

ABSTRACT This study represents a timely investigation that addresses race/ethnic disparities in type 2 diabetes (T2DM) care over a period that included a major pandemic shock. T2DM is burdensome and disproportionately impacts vulnerable and disenfranchised populations; of note, there are stark race/ethnic disparities in T2DM care goals, emergency department (ED) visits, and hospitalizations. Medicaid covers 25% of Americans with T2DM. More than 80% of Medicaid beneficiaries nationally receive at least some of their care from Medicaid managed care organizations (MMCO). States contract with private (non-profit or for-profit) MMCOs to lower costs, increase quality, and pass on financial risks of covering Medicaid beneficiaries. Heterogeneity across and within state programs can have implications for quality of T2DM care and, specifically, race/ethnic disparities through benefit generosity or by affecting MMCO entry and post-entry behavior. State policymakers also have significant influence over marketplaces in which MMCOs compete, which can have consequences for race/ethnic disparities, given that Medicaid disproportionately covers non-white populations. Little is known about whether and how MMCOs and the state programs they operate in influence disparities in T2DM care and, if or how the COVID-19 pandemic changed the trajectory of health disparities. We propose to answer these unknowns using a convergent mixed-methods study: we will compile a database of MMCO/state program features that could influence care using a health disparities conceptual framework (Aim 1); we will empirically explore race/ethnic disparities among adults with T2DM and whether these vary by MMCO/state features and pre-/post-COVID-19 using comprehensive data from the Transformed Medicaid Statistical Information System over 2016-2025 (Aims 2 and 3); and we will collect and analyze qualitative data from Medicaid stakeholders to triangulate and contextualize the quantitative findings (Aim 4). We focus on non- disabled, non-pregnant 18-64-year-old adults with T2DM who tend to remain stably covered by Medicaid over time. To reduce selection bias, we focus our analyses on 12 states and the District of Columbia that mandate enrollment in comprehensive MMCOs. We will use panel data models to examine race/ethnic and sex-specific receipt of key T2DM services and ED visits and hospitalizations, overall and by MMCO/state features. We will also follow a continuously enrolled cohort over 2020-2025 to assess if and how MMCO/state program features moderate the pandemic’s effects on T2DM disparities. Sensitivity analyses will explore the influence of churn. Further, our preliminary analyses identify Kentucky and Florida as having the lowest and highest disparities in T2DM care, respectively; we will conduct interviews in these states to examine what MMCO/state features and implementation might explain these disparities. This policy-relevant work will provide critical insights into how Medicaid managed care programs can be designed to reduce disparities in chronic disease burdens.

抽象的 这项研究代表了一项及时的调查，旨在解决 2 型糖尿病 (T2DM) 中的种族/民族差异 包括重大流行病冲击期间的护理。 T2DM 是一种负担和不成比例的影响 弱势群体和被剥夺权利的群体；值得注意的是，T2DM 护理目标存在明显的种族/民族差异， 急诊科 (ED) 就诊和住院治疗。医疗补助覆盖了 25% 的美国 T2DM 患者。更多的 全国超过 80% 的医疗补助受益人至少部分接受医疗补助管理式医疗服务 组织（MMCO）。各州与私人（非营利或营利）MMCO 签订合同，以降低成本、提高 质量，并转嫁医疗补助受益人的财务风险。州内和州内的异质性 计划可能会对 T2DM 护理质量产生影响，特别是通过以下方式影响种族/民族差异： 受益于慷慨或影响 MMCO 进入和进入后行为。国家政策制定者也有 对 MMCO 竞争的市场产生重大影响，这可能会对 鉴于医疗补助不成比例地覆盖非白人人口，种族/民族差异。鲜为人知 关于 MMCO 及其运作的州计划是否以及如何影响 T2DM 护理的差异 以及 COVID-19 大流行是否或如何改变了健康差异的轨迹。我们建议回答 使用收敛混合方法研究这些未知数：我们将编译 MMCO/状态数据库 使用健康差异概念框架可能影响护理的计划特征（目标 1）；我们将 实证探索 T2DM 成人患者的种族/民族差异，以及这些差异是否因 MMCO/州而异 使用来自转换后的医疗补助统计数据的综合数据来了解新冠肺炎 (COVID-19) 之前/之后的特征和情况 2016-2025 年信息系统（目标 2 和 3）；我们将收集并分析来自的定性数据 医疗补助利益相关者对定量结果进行三角测量和背景分析（目标 4）。我们专注于非 残疾、非怀孕的 18-64 岁患有 T2DM 的成年人，他们往往在超过 20 年的时间里稳定地享受医疗补助 时间。为了减少选择偏差，我们将分析重点放在 12 个州和哥伦比亚特区，这些州和哥伦比亚特区强制要求 综合 MMCO 的注册。我们将使用面板数据模型来检查种族/民族和特定性别 接受关键 T2DM 服务以及急诊就诊和住院治疗的总体情况以及按 MMCO/州特征划分的情况。我们将 还跟踪 2020-2025 年持续注册的队列，以评估 MMCO/州计划是否具有特征以及如何具有特征 缓和大流行对 T2DM 差异的影响。敏感性分析将探讨客户流失的影响。 此外，我们的初步分析表明，肯塔基州和佛罗里达州的差异最低和最高。 T2DM 分别护理；我们将在这些州进行采访，以了解 MMCO/州的特点和 实施可能可以解释这些差异。这项与政策相关的工作将为如何 医疗补助管理式医疗计划旨在减少慢性病负担的差异。