Policy Dissemination Strategies to Improve the Use of Research Evidence in Medicaid Benefits for Opioid Use Disorder Treatment

项目总结/摘要 K 01指导研究职业发展奖的目的是支持申请人 在推进和最大限度地提高她的研究技能，以启动一个独立的研究生涯中， 为安全网人口传播和实施循证药物使用治疗。安全 净人口，特别是由医疗补助和儿童健康保险公共保险的个人 计划（CHIP）受到美国阿片类药物流行病的不成比例的影响。尽管有很大的需求 在治疗方面，这一人群对阿片类药物使用障碍（MOUD）的救生药物使用不足。低 MOUD的使用是由无数不一致的联邦、州、医疗补助/芯片机构和管理式医疗驱动的 根据不同程度的证据制定组织效益和利用管理政策。联邦政策 需要所有三个MOUD（即，丁丙诺啡，美沙酮，纳洛酮）被列为强制性医疗补助状态 计划福利，但不是所有的州都遵守了，医疗保险和医疗补助服务中心 承认强制覆盖是不可行的。即使医疗补助/芯片机构涵盖所有三个 MOUD，他们可以通过首选药物列表，失败优先，事先和重新授权要求限制访问，因此 对受益人造成可能危及生命的护理延误。管理式护理组织（MCO）， 许多签约管理福利的州机构可以制定附加的利用管理政策， 限制MOUD访问。需要进行研究，以促进医疗补助/CHIP和MCO政策制定者使用科学的 设计MOUD福利时的证据。在Gregory Aarons博士的指导下（赞助商和导师） 和一个专家指导团队，申请人将继续培训：（1）调查设计，（2）多元统计 分析，包括潜在类分析和有限混合模型;（3）政策传播策略 发展，包括为决策者包装和传达证据，以及（4）开展研究 与政策相关的决策者建立伙伴关系。这些培训目标将有助于完成研究 旨在：（1）制定和管理一项针对医疗补助/CHIP机构和MCO决策者的全国性调查， 识别影响其证据使用行为的决定因素、机制和中介;（2） 根据医疗补助/CHIP机构和MCO的不同子组， 设计MOUD效益时的证据使用行为;（3）设计和试点测试的可接受性， 传播战略的适当性和可行性，为每个潜在阶层量身定制，以促进 政策制定者关于MOUD效益的循证决策。该提案与NIDA的 评估物质使用障碍相关联邦、州和系统政策影响的战略目标 公共卫生，并确定战略中介机构和政策执行战略， 在政策中使用证据。计划的K 01活动将有效地定位申请人，以实现独立的 研究生涯的重点是改善获得循证药物使用治疗。

PROJECT SUMMARY/ABSTRACT The purpose of this proposed K01 Mentored Research Career Development Award is to support the applicant in advancing and maximizing her research skills in order to launch an independent research career in the dissemination and implementation of evidence-based substance use treatment for safety net populations. Safety net populations, especially individuals who are publicly insured by Medicaid and the Children’s Health Insurance Program (CHIP), have been disproportionately impacted by the U.S. opioid epidemic. Despite a significant need for treatment, lifesaving medications for opioid use disorder (MOUD) are underused by this population. Low MOUD use is driven by a myriad of misaligned federal, state, Medicaid/CHIP agency and managed care organization benefit and utilization management policies informed by varying levels of evidence. Federal policy requires all three MOUD (i.e., buprenorphine, methadone, naltrexone) be included as mandatory Medicaid state plan benefits, but not all states have complied, and the Centers for Medicare and Medicaid Services acknowledges that enforcing coverage is not feasible. Even when Medicaid/CHIP agencies cover all three MOUD, they can restrict access via preferred drug lists, fail-first, prior and re-authorization requirements – thus imposing potentially life-threatening care delays on beneficiaries. Managed care organizations (MCOs) that many state agencies contract to administer benefits can enact additional utilization management policies that limit MOUD access. Research is needed to promote Medicaid/CHIP and MCO policymakers’ use of scientific evidence when designing MOUD benefits. Under the mentorship of Dr. Gregory Aarons (sponsor and mentor) and an expert mentoring team, the applicant will pursue training in: (1) survey design, (2) multivariate statistical analysis, including latent class analysis and finite mixture modeling, (3) policy dissemination strategy development, including packaging and communicating evidence for policymakers, and (4) developing research partnerships with policy-relevant decision-makers. These training goals will facilitate accomplishing research aims to: (1) develop and administer a national survey to Medicaid/CHIP agency and MCO policymakers to identify determinants, mechanisms, and intermediaries that influence their evidence use behaviors; (2) empirically identify and describe distinct subgroups of Medicaid/CHIP agencies and MCOs based on their evidence use behaviors when designing MOUD benefits; (3) design and pilot test the acceptability, appropriateness and feasibility of dissemination strategies, tailored to each latent class, for promoting policymakers’ evidence-based decision-making regarding MOUD benefits. This proposal is aligned with NIDA’s strategic objectives to assess the impact of substance use disorder-related federal, state and systems policies on public health, and to identify strategic intermediaries and policy implementation strategies aimed at improving evidence use in policy. The planned K01 activities will effectively position the applicant to achieve an independent research career focused on improving access to evidence-based substance use treatment.