The Effects of Statewide Comprehensive Integrated Care for Medicaid Enrollees.

项目摘要 在提供精神卫生服务方面，公共保险的设计是一个至关重要的政策问题。大 许多研究已经证明，综合护理模式对患者有实质性的好处， 在一个环境中获得初级身心保健。然而，广泛采用集成 护理模式没有出现。一个关键和持续的障碍是资金筹措和支付分离， 身心健康服务，特别是医疗补助中的心理健康“分割”形式 程序.分割被认为会造成障碍，阻碍综合护理的理想潜力。 为了了解各州广泛传播综合护理的潜力，我们建议研究华盛顿 国家的“综合管理护理”（IMC）倡议。根据这项计划，医疗补助受益人将获得 通过单一的综合管理式护理计划提供全面的身心健康服务。的 在2016-2020年期间，以交错方式实施IMC， 分配到必须从现有的分拆系统过渡到整合营销传播的五个浪潮之一。这种自然 实验创造了一个机会，一个强大的定量和定性研究的影响，充分（金融） 身心健康一体化。我们的提案利用了华盛顿的综合客户端 数据库系统是一个独特的资源，将医疗补助要求与健康的社会决定因素的丰富措施联系起来， 包括住房、就业和与刑事司法系统的联系。 拟议的研究旨在加强我们对国家如何促进综合利用的理解。 照顾，包括可能促进或阻碍一体化的因素，以及全面的金融一体化是否可以 影响资源使用或影响健康的社会决定因素。我们试图填补这些知识空白， 希望为美国的医疗补助机构和卫生系统提供可操作的信息，解决 关于金融一体化的可行性和好处的问题，并提供有关切入或 开拓服务，促进临床层面整合的因素，以及社会 严重精神病患者的服务需求受到影响。这项工作与以下方面密切相关： NIMH的战略目标4.1是“提高现有精神卫生服务的效率和有效性”， 其中包括研究“为患有严重精神疾病的成人和儿童优化融资模式， 在公共和私人医疗保健系统中提供高效和有效的护理。”一个强大的 自然实验，详细的背景数据和丰富的结果将使我们能够开发出严格的， 指导医疗补助中提供心理健康服务的可操作证据。

PROJECT SUMMARY The design of public insurance in providing mental health services is a critically important policy issue. A large number of studies have demonstrated substantial benefits for patients in integrated care models, which allow access to primary physical and mental health care in one setting. However, widespread adoption of integrated care models has not occurred. A critical and continuing barrier is the separation of financing and payment for physical and mental health services, particularly in the form of mental health “carve-outs” in Medicaid programs. Carve-outs are perceived to create barriers and hamper the aspirational potential of integrated care. To understand the potential for states to widely disseminate integrated care, we propose to study Washington State’s “Integrated Managed Care” (IMC) initiative. Under this initiative, Medicaid beneficiaries will receive comprehensive physical and mental health services through a single, integrated managed care plan. The implementation of IMC takes place in a staggered fashion over the 2016-2020 timespan, with counties assigned to one of five waves that must transition from the existing carve-out system to IMC. This natural experiment creates an opportunity for a robust quantitative and qualitative study of the effects of full (financial and service) integration of physical and mental health. Our proposal leverages Washington’s Integrated Client Database System, a unique resource linking Medicaid claims to rich measures of social determinants of health, including housing, employment, and contacts with the criminal justice system. The proposed research seeks to enhance our understanding of how states can advance the use of integrated care, including the factors that may facilitate or hinder integration, and whether full financial integration can affect resource use or impact social determinants of health. We seek to fill these gaps in knowledge with the hope of providing actionable information to Medicaid agencies and health systems across the U.S., addressing questions about the feasibility and benefits of financial integration, with specific information about carving in or carving out services, the factors that facilitate integration at the clinical level, and the ways in which social service needs among individuals with severe mental illness are affected. This work is closely aligned with NIMH’s Strategic Objective 4.1 to “improve the efficiency and effectiveness of existing mental health services,” which includes research to “optimize financing models for adults and children with serious mental illnesses to provide efficient and effective care in public and private health care systems.” The combination of a strong natural experiment, detailed contextual data, and a rich set of outcomes will allow us to develop rigorous and actionable evidence to guide the provision of mental health services in Medicaid.