Impact of Medicaid ACO funding for health-related social needs on dietary quality and health

尽管在治疗方面取得了重大进展，但癌症和心脏代谢结果之间的差距仍在继续扩大 由于社会经济地位的不同。粮食和住房不安全是健康的社会决定因素， 与肥胖、糖尿病、心血管疾病和心理压力的发病率有关，以及 粮食不安全导致了癌症死亡率的收入差距。尽管社会与社会之间的联系 需求和健康是明确定义的，但在解决粮食问题的政策或方案方面存在研究空白 和住房不安全，特别是通过卫生系统，改善饮食、肥胖、健康和医疗保健 利用率。一些州正在医疗补助计划中试验责任护理组织(ACO) 旨在激励提供者和组织提供更高价值医疗服务的计划，以及一些 ACO开始满足社会需求。2020年1月，马萨诸塞州将首次 直接向医疗补助ACO提供资金，通过交付系统解决食品和住房需求 改革奖励支付弹性服务计划。这项计划的实施是一次自然的实验 这可能提供关于州一级为粮食和住房需求提供资金对 饮食和健康结果。本研究的主要目标是评估灵活服务计划如何 影响成人ACO参与者的饮食质量、心理压力、健康和保健利用 评估计划的实施情况。该项目将在五个社区卫生中心(CHC)进行 隶属于Partners Healthcare，这是一家大型医疗保健组织，已作为 医疗补助ACO。该项目是时间敏感的，因为计划前对饮食的实施评估， 压力、粮食/住房不安全和获得资源必须在#年方案实施之前完成。 2020年。共有800名医疗补助ACO患者(Med-ACO)和200名非Medicaid CHC患者提供食物/住房 不安全(控制)将注册并跟踪4年。调查，24小时饮食召回(ASA24)，电子 健康记录(EHR)和索赔数据将被收集。主要结果将是饮食质量的变化， 压力、食物/住房不安全(目标1)以及体重指数、血压和急性健康的变化 护理利用情况(急诊科就诊；住院)(目标2)比较：a)Med-ACO参与者 世卫组织在实施与控制前对食品/住房不安全进行阳性筛查，以及b)Med-ACO参与者 食物/住房筛查呈阳性并接受灵活服务(暴露)与Med-ACO参与者 屏幕是肯定的，但不接受灵活服务(未公开)。目标3将评估实施因素 这影响了RE-AIM/PRISM框架指导下的计划的有效性。结果将通知 政策制定者和研究人员对一项新的州级粮食和食品供应计划的有效性进行了讨论 通过医疗补助ACO提供住房资源，并将帮助完善正在进行的和未来的州和社区 这些计划将减少癌症和心脏代谢性疾病的收入差距。

Despite major advances in therapies, disparities in cancer and cardiometabolic outcomes continue to widen due to differences in socioeconomic status. Food and housing insecurity are social determinants of health that are associated with morbidity from obesity, diabetes, cardiovascular disease, and psychological stress, and food insecurity contributes to income disparities in cancer mortality. Although the associations between social needs and health are well-defined, there is a research gap as to whether policies or programs to address food and housing insecurity, particularly through health systems, improve diet, obesity, health, and healthcare utilization. Some states are experimenting with Accountable Care Organizations (ACOs) in their Medicaid programs with the goal of incentivizing providers and organizations to deliver higher value care, and some ACOs are starting to address social needs. In January 2020, the state of Massachusetts will, for the first time, provide funding directly to Medicaid ACOs to address food and housing needs through the Delivery System Reform Incentive Payment Flexible Services program. Implementation of this program is a natural experiment that could provide important knowledge about the impact of state-level funding for food and housing needs on diet and health outcomes. The main objectives of this study are to evaluate how the Flexible Services program affects the dietary quality, psychological stress, health, and health care utilization of adult ACO participants and to assess program implementation. The project will take place at five community health centers (CHCs) affiliated with Partners HealthCare, a large health care organization that has contracted with the state as a Medicaid ACO. The project is time-sensitive because the pre-program implementation assessment of diet, stress, food/housing insecurity, and access to resources must be completed before program implementation in 2020. A total of 800 Medicaid ACO patients (Med-ACO) and 200 non-Medicaid CHC patients with food/housing insecurity (Control) will be enrolled and followed for 4 years. Survey, 24-hour dietary recall (ASA24), electronic health record (EHR), and claims data will be collected. Primary outcomes will be change in dietary quality, stress, and food/housing insecurity (Aim 1) and change in body mass index, blood pressure, and acute health care utilization (emergency department visits; hospitalizations) (Aim 2) comparing: a) Med-ACO participants who screen positive for food/housing insecurity pre-implementation vs. Control, and b) Med-ACO participants who screen positive for food/housing and receive Flexible Services (exposed) vs. Med-ACO participants who screen positive but do not receive Flexible Services (not exposed). Aim 3 will assess implementation factors that influence the effectiveness of the program, guided by the RE-AIM/PRISM framework. Results will inform policymakers and researchers about the effectiveness of a novel state-level program for delivering food and housing resources through Medicaid ACOs and will help refine ongoing and future state and community programs that will reduce income disparities in cancer and cardiometabolic disease.