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

项目摘要 2016年，六分之一的6-17岁儿童有行为健康（BH）诊断，估计攀升至 在COVID-19大流行期间超过四分之一。长期以来，对BH服务的有限访问一直是 对大多数孩子的挑战。努力解决专业BH护理系统的缺点，例如 将BH护理纳入儿科初级护理环境，以及提供电话精神病学的州计划 与儿科医生的协商有助于改善护理，但护理方面的巨大差距和差异仍然存在。 问责护理组织（ACO）激励护理整合和人口健康， 社区-保健联系、保健协调和干预措施，以解决健康的社会决定因素。 ACO引入的创新改革有可能改善BH护理服务，但其对 儿科人群基本上是未知的。对成年人的研究表明， 组织特征（例如，合同类型）可能会提高慢性病的护理质量，但少数 关于ACO对儿童护理质量和结果的影响的研究并没有集中在这个大的， 高风险人群的儿童与BH障碍。这项研究将是第一个解决这一关键差距， 通过利用发生在马萨诸塞州（MA）的自然实验， 高患病率的儿童与BH诊断。2018年，MA推出了17个新的Medicaid ACO， 异构组织特征（例如，规模;医生与医院主导;年龄组合。我们将利用MA 创新的Medicaid ACO“实验”，使用混合方法解决以下目标：1）评估 ACO对BH护理质量、结果和医疗保险儿童差异的影响; 2）了解 ACO异质性改变了ACO对BH质量和结局的影响; 3）确定 父母报告的儿童行为健康护理经验与儿童行为健康护理的组织特征之间的关系， 医疗补助助理审计官。需要对医疗保健进行根本性改革，以解决社会经济和种族/民族问题。 波黑对弱势群体儿童的护理质量和结果存在差异。我们的创新混合 方法的方法，以检查接触到一个新的异质组的医疗补助之间的关联 ACO和BH护理和结果使用州一级的行政索赔和调查数据以及关键信息提供者 与ACO领导人和家长的访谈开始，以解决这一巨大的知识差距。这些新信息 预计将使负责照顾弱势群体的提供者、支付者和政策制定者受益 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.