Effect of Medicaid Accountable Care Organizations on Behavioral Health Care Quality and Outcomes for Children

项目总结 2016年，每六名6-17岁的儿童中就有一人被诊断为行为健康(BH)，据估计， 在新冠肺炎大流行期间，每四个人中就有一个以上。对BH服务的有限访问长期以来一直存在 对大多数孩子来说都是挑战。努力解决BH专科护理系统的缺点，例如 将BH保健整合到儿科初级保健环境中，以及提供电话精神病学的州项目 向儿科医生咨询有助于改善护理，但护理方面的巨大差距和差距依然存在。 负责任的护理组织(ACO)鼓励护理一体化和人口健康，从而促进 社区-卫生保健联系、护理协调和干预措施，以解决健康的社会决定因素。 ACOS推出的创新改革有可能改善BH护理提供，但它们对 儿科人口在很大程度上是未知的。对成年人群的研究表明，患有某些疾病的ACOs 组织特征(例如，合同类型)可能会提高慢性病的护理质量，但 有关ACOs对儿童护理质量和结局的影响的研究并没有集中在这么大的， 患有BH疾病的儿童的高危人群。这项研究将是第一个解决这一关键差距的研究 通过利用在马萨诸塞州(MA)进行的自然实验获得知识，马萨诸塞州拥有 确诊为BH的儿童患病率较高。2018年，马萨诸塞州推出了17个新的医疗补助ACO 不同的组织特征(例如，规模；医生与医院主导；年龄结构。我们将利用MA的 创新的医疗补助ACO‘实验’，以解决以下目标，使用混合方法：1)评估 ACO对医疗补助参保儿童的BH护理质量、结果和差异的影响；2)了解如何 ACO的异质性改变了ACO对BH质量和预后的影响；3)决定了这种关系 父母报告的子女行为保健经验与组织特征之间的关系 医疗补助ACO。需要在医疗保健方面进行根本性改革，以解决社会经济和种族/民族问题 脆弱人群中儿童的BH护理质量和结果方面的差异。我们的创新混合 检查暴露于新的不同种类的医疗补助群体之间的联系的方法 ACOS和BH护理和结果使用州级管理声明和调查数据以及关键信息 采访ACO领导人和家长，开始解决这一巨大的知识差距。这一新信息 预计将使负责照顾弱势群体的提供者、付款人和政策制定者受益 患有BH障碍的儿童。

PROJECT SUMMARY One in six children aged 6-17 years had a behavioral health (BH) diagnosis in 2016, with estimates climbing to more than one in four during the COVID-19 pandemic. Limited access to BH services has long presented challenges for most children. Efforts to address the shortcomings of the specialty BH care system, such as integrating BH care into pediatric primary care settings, and state programs that offer telephonic psychiatry consultation to pediatricians, have helped improve care, but immense gaps in care and disparities persist. Accountable care organizations (ACOs) incentivize care integration and population health, which promotes community-health care linkages, care coordination, and interventions to address social determinants of health. The innovative reform introduced by ACOs has the potential to improve BH care delivery, but their impact for pediatric populations is largely unknown. Studies of adult populations suggest that ACOs with certain organizational features (e.g., type of contract) may improve quality of care for chronic diseases but the few studies of the impact of ACOs on quality of care and outcomes for children have not focused on this large, high-risk population of children with BH disorders. This study will be the first to address this critical gap in knowledge by taking advantage of the natural experiment taking place in Massachusetts (MA), a state with a high prevalence of children with BH diagnoses. In 2018, MA, launched 17 new Medicaid ACOs with heterogeneous organizational features (e.g., size; physician vs. hospital-led; age mix. We will leverage MA’s innovative Medicaid ACO ‘experiment’ to address the following aims using mixed methods: 1) Evaluate the impact of ACOs on BH care quality, outcomes, and disparities for Medicaid-insured children; 2) Discern how ACO heterogeneity modifies ACOs’ effects on BH quality and outcomes; 3) Determine the relationship between parent reported experience with their child’s Behavioral Health care and organizational features of the Medicaid ACOs. Fundamental changes in healthcare are needed to address socioeconomic and racial/ethnic disparities in BH care quality and outcomes for children in vulnerable populations. Our innovative mixed methods approach to examining the association between exposure to a new heterogeneous group of Medicaid ACOs and BH care and outcomes uses state-level administrative claims and survey data and key informant interviews with ACO leaders and parents to begin to address this large gap in knowledge. This new information is expected to benefit providers, payers, and policy makers responsible for the care of vulnerable populations of children with BH disorders.