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

尽管治疗取得了重大进展，但癌症和心脏代谢结局的差异继续扩大 由于社会经济地位的不同。粮食和住房无保障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有关， 粮食无保障造成了癌症死亡率方面的收入差距。虽然社会关系 需要和健康是明确的，有一个研究差距，是否政策或计划，以解决粮食 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 利用率一些州正在其医疗补助计划中试验责任医疗组织（ACO） 目标是激励提供者和组织提供更高价值的护理的计划， ACO开始解决社会需求。2020年1月，马萨诸塞州将首次， 直接向Medicaid ACO提供资金，以通过交付系统解决食品和住房需求 改革奖励性支付灵活服务方案。这个计划的实施是一个自然的实验 这可以提供关于国家一级为粮食和住房需求提供资金的影响的重要知识， 饮食和健康结果。本研究的主要目的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、健康和卫生保健利用， 评估方案实施情况。该项目将在五个社区卫生中心（CHC）进行 附属于合作伙伴医疗保健，一个大型医疗保健组织，已与国家作为一个 Medicaid ACO.该项目是时间敏感的，因为预计划实施评估的饮食， 压力，粮食/住房不安全和获得资源必须在计划实施之前完成， 2020.共有800名Medicaid ACO患者（Med-ACO）和200名非Medicaid CHC患者， 不安全（对照）将入组并随访4年。调查，24小时饮食回忆（ASA 24），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， 压力和粮食/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（急诊科就诊;住院）（目标2）比较：a）Med-ACO参与者 实施前与对照组相比，食物/住房不安全筛查呈阳性，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）的受试者与 屏幕正面，但不接受灵活服务（不暴露）。目标3将评估执行因素 这影响了该计划的有效性，由RE-AIM/PRISM框架指导。结果将通知 政策制定者和研究人员对一个新的国家级计划的有效性提供粮食， 通过医疗补助ACOs的住房资源，并将有助于完善正在进行和未来的国家和社区 减少癌症和心脏代谢疾病收入差距的项目。

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.