Medicaid Accountable Care Organizations (ACO) and Quality of Care for Adults with Serious Mental Illness (SMI)

医疗补助责任护理组织 (ACO) 和患有严重精神疾病的成人的护理质量 (SMI)

• 批准号: 10591570
• 负责人: Anna Goldman
• 金额: $ 18.94万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-14 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10591570
• 关键词: Address; Adult; Affect; Ambulatory Care; American; Benchmarking; Caring; Case Manager; Cessation of life; Characteristics; Chronic Care; Data; Development Plans; Drops; Enrollment; Evolution; Funding; General Population; Goals; Health; Health Insurance; Health Policy; Health Services Accessibility; Healthcare; Homelessness; Hospital Administrators; Hospitals; Incentives; Individual; Insurance Claim Review; Interview; Investigation; Leadership; Low income; Massachusetts; Measures; Medicaid; Medical; Medicare; Mental Health; Methods; Modeling; National Institute of Mental Health; Natural experiment; Organizational Affiliation; Organizational Models; Outcome; Patient Care; Patients; Perception; Policies; Policy Maker; Population; Proliferating; Provider; Quality Indicator; Quality of Care; Randomized; Research; Research Personnel; Selection Bias; Shapes; Source; Strategic Planning; Structure; System; accountable care organization; barrier to care; care coordination; career development; comorbidity; experience; health care delivery; health care service organization; hospital readmission; improved; insight; parity; participant enrollment; patient population; payment; premature; programs; risk selection; severe mental illness; social; social adversity; social vulnerability; tool

PROJECT SUMMARY Individuals with serious mental illness (SMI) are three times more likely to die prematurely than the general population. Sixty percent of this premature death is attributable to inadequate care of chronic, co-morbid medical conditions. A growing proportion of patients with SMI receive care in accountable care organizations (ACOs) – health care delivery and finance systems, in which global payments and quality benchmarks are used to incentivize quality care and lower spending. An increasing number of states are implementing ACO models in their Medicaid programs, the primary source of health insurance for low-income Americans with SMI. Medicaid ACOs exist in 12 states, caring for over 6% of the Medicaid population. Medicaid ACOs have the potential to both improve and worsen access to, and quality of, care for low-income adults with SMI. While financial structures that incentivize care coordination and programs that address health-related social needs likely benefit those with SMI, inadequate global payments that fail to account fully for social adversities such as homelessness could result in lower quality care. Certain features of Medicaid ACOs, e.g. leadership structure or ACO size, may amplify the benefits or drawbacks of the ACO model for patients with SMI. Evidence from Medicare ACOs has shown that smaller, provider-led ACOs and those serving a lower proportion of socially- vulnerable patients perform better in terms of quality. However, no evidence exists on how Medicaid ACO characteristics affect quality of care or the care experience of SMI adults. Since Medicaid ACOs are rapidly proliferating, filling this evidence gap is critical and can inform the evolution of the ACO model to better achieve the goal of mental health parity. In this K23 research plan, we propose to identify features of Medicaid ACOs (e.g. provider-led vs. hospital-led ACOs) that produce the highest quality ACO care for adults with SMI. We will undertake this research objective in three critical domains. First, we will study whether certain ACO types tend to drop patients with SMI, a practice known as favorable risk selection (or “cherry-picking”). This phenomenon can cause instability of ACO enrollment for patients, itself a marker of lower quality care. Second, we will compare care access and quality among adults receiving care in different ACO types. Lastly, we will use mixed methods to examine the care experiences of adults with SMI receiving care in different ACO types, through in-depth interviews and subsequent integration of qualitative and quantitative findings. For the first two aims, we will use Massachusetts All-Payer Claims Data and leverage the state’s unique auto- assignment mechanism as a natural experiment to study favorable risk selection, access, and quality. Auto- assignment refers to Medicaid randomly assigning individuals to ACOs, allowing us to compare outcomes across ACO types without selection bias caused by patients self-selecting their ACO affiliation. The goal of my K23 research is to guide policymakers and hospital administrators in shaping the Medicaid ACO model to produce more stable, higher-quality ACO care for patients with SMI.

项目摘要 患有严重精神疾病（SMI）的人过早死亡的可能性是一般的三倍 人口。这种过早死亡的60％归因于对慢性，莫比利的护理不足 医疗状况。越来越多的SMI患者在负责任的护理组织中接受护理 （ACO） - 全球付款和优质基准是医疗保健交付和金融系统 用于增加质量护理和降低支出。越来越多的州正在实施ACO 他们的Medicaid计划中的模型是SMI低收入美国人的健康保险的主要来源。 医疗补助ACO存在于12个州，占医疗补助人口的6％以上。医疗补助ACO有 有可能改善和更差的SMI低收入成年人获得和质量的护理质量。尽管 激励护理协调和计划以满足健康相关社会需求的计划的财务结构 可能受益于SMI，全球付款不足的人，这些付款无法完全解释社会逆境，例如 无家可归可能会导致质量较低的护理。医疗补助ACO的某些功能，例如领导结构 或ACO大小，可以扩大SMI患者的ACO模型的好处或缺点。来自 Medicare ACOS已表明，以提供商为主导的ACO和在社会上较低比例的ACO的ACO- 脆弱的患者在质量方面表现更好。但是，没有证据表明医疗补助如何 特征会影响护理质量或SMI成年人的护理经验。由于医疗补助ACO迅速 扩散，填补这一证据差距至关重要，并且可以告知ACO模型的演变以更好地实现 心理健康均等的目标。在此K23研究计划中，我们建议确定医疗补助ACO的功能 （例如，由提供者领导的与医院主导的ACO）为患有SMI的成年人提供最高质量的ACO护理。我们 将在三个关键领域实现这一研究目标。首先，我们将研究某些ACO类型 倾向于将SMI的患者放下，这种做法被称为有利的风险选择（或“挑剔”）。这 现象可能会导致患者的ACO入学率不稳定，这本身就是质量较低的护理的标志。 其次，我们将比较接受不同ACO类型的成年人的护理访问和质量。最后， 我们将使用混合方法来检查成年人在不同ACO中接受护理的成年人的护理经验 通过深入的访谈以及随后的定性和定量发现的整合。为了 前两个目标，我们将使用马萨诸塞州的全付款人索赔数据，并利用该州独特的自动 分配机制是一种自然实验，以研究有利的风险选择，获取和质量。汽车- 任务是指随机分配给ACO的医疗补助，使我们能够比较结果 在没有选择偏倚的ACO类型中，患者自我选择其ACO会员。我的目标 K23研究是指导政策制定者和医院管理员，将医疗补助ACO模型塑造为 为SMI患者产生更稳定的高质量ACO护理。