Treatment for Alcohol Use Disorder in Medicaid Managed Care

项目摘要 随着国家继续努力应对与酒精相关的住院和死亡率上升，扩大获得酒精的机会， 酒精使用障碍（AUD）治疗仍然是一个紧迫的公共卫生优先事项。虽然医疗补助的定位是 成为改善AUD治疗的可及性和降低弱势群体死亡率的关键政策杠杆， 许多州的医疗补助计划并不涵盖AUD治疗和使用的全部连续性 可能限制访问的管理参数。此外，大多数州医疗补助计划与 管理式护理组织（MCOs）。虽然超过70%的医疗补助注册者参加了MCO计划， 了解这些计划如何涵盖AUD治疗。为了填补科学证据的空白，我们将进行 第一项关于Medicaid MCO覆盖范围和利用管理设计对AUD影响的多州研究 治疗效果和结果。该研究将全面涵盖18个州的142个MCO计划 连续治疗。我们还建议在两个方面使用创新的随机自动分配方法 州医疗补助计划。我们的具体目标将包括：（1）估计MCO计划的覆盖范围， 利用管理设计与识别的主要阶段的进展有关， AUD的治疗（诊断、启动、参与和保留）;（2）估计MCO计划的覆盖范围 和使用管理参数与酒精相关的急诊科就诊相关， 住院治疗;以及（3）估计如何通过AUD的识别和治疗阶段进展 与酒精相关的死亡率有关。这项拟议的研究将是第一次全面调查 AUD治疗的MCO覆盖范围对治疗接受和结局的影响-没有证据 大部分AUD人群的护理受到损害。由于酒精相关的住院治疗， 死亡率继续上升，关于医疗补助MCO覆盖范围对AUD治疗影响的证据是 迫切需要。这项研究将为政策制定者提供基于证据的指导， MCO合同安排，以确保适当和有效地获得AUD治疗。 1

PROJECT SUMMARY As the nation continues to grapple with rising alcohol-related hospitalization and mortality, expanding access to alcohol use disorder (AUD) treatment remains an urgent public health priority. While Medicaid is positioned to be a key policy lever to improve access to AUD treatment and reduce mortality among vulnerable populations, many state Medicaid programs do not cover the full continuum of AUD treatment and use utilization management parameters that may restrict access. Moreover, most state Medicaid programs contract with managed care organizations (MCOs). While over 70% of all Medicaid enrollees participate in MCO plans, little is known about how these plans cover AUD treatment. To fill this gap in the scientific evidence, we will conduct the first multi-state study of the effects of Medicaid MCO coverage and utilization management design on AUD treatment receipt and outcomes. The study will encompass 142 MCO plans, across 18 states, for the full continuum of treatment. We also propose to make use of innovative random auto-assignment methods in two state Medicaid programs. Our specific aims will include: (1) estimating how MCO plans’ coverage and utilization management designs are associated with progression through the major stages of identification and treatment of AUD (diagnosis, initiation, engagement, and retention); (2) estimating how MCO plans’ coverage and utilization management parameters are associated with alcohol-related emergency department visits and hospitalizations; and (3) estimating how progression through the stages of identification and treatment of AUD is associated with alcohol-related mortality. The proposed study will be the first comprehensive investigation of the effects of MCO coverage for AUD treatment on treatment receipt and outcomes – evidence without which the care of a large fraction of the AUD population is compromised. As alcohol-related hospitalization and mortality continue to rise, evidence regarding the impact of Medicaid MCO coverage for AUD treatment is urgently needed. This research will equip policymakers with evidence-based guidance on how to structure MCO contractual arrangements to ensure appropriate and efficient access to AUD treatment. 1