Improving racial equity in opioid use disorder treatment in Medicaid

摘要 获得治疗阿片类药物使用障碍(MOUD)的药物是不公平的。黑人和西班牙裔美国人 接受Moud和其他过量预防服务的可能性大大降低。服药过量死亡率 近年来，黑人个人的增长速度几乎是白人个人的两倍，这一差距 似乎在新冠肺炎大流行期间有所扩大。接受穆德的种族/民族不平等是 根植于医疗保健、住房、社会服务、刑事政策中根深蒂固的结构性种族主义 司法和其他制度。作为穆德最大的单一支付者和种族/民族覆盖的主要来源 作为少数群体，医疗补助计划处于有利地位，可以解决穆德的不平等问题。尽管他们还没有这样做 到目前为止，医疗补助机构可以采取政策来改变(A)对Moud提供者的财政激励，以及(B) 与管理保健计划的合同，以提高穆德的股权。医疗补助计划可以建立 对提供者网络的要求；投资建设为少数族裔服务的医疗补助提供者的能力，以 提供Moud；将公平衡量纳入提供者绩效衡量；以及改变管理型医疗服务 合同激励解决穆德不平等问题的计划。然而，几乎没有证据表明是哪种 这些杠杆最有可能是有效的。为了向医疗补助政策发展提供信息，我们利用医疗补助 成果分布研究网络(MODRN)，由大学与医疗补助计划的合作伙伴组成 11个州的医疗机构，占美国医疗补助登记人数的22%。MODRN目前由NIDA资助，以 研究医疗补助中阿片类药物使用障碍治疗的质量，并开发了分析基础设施以 在医疗补助中对Moud的治疗进行多状态分析。我们提出了分析，以检验这一角色 在穆德推动种族/族裔不平等的场所、提供者、计划和政策。首先，我们检查 医疗补助参与者在地域上获得穆德服务提供者方面的种族/民族不平等。第二，我们 审查提供者和计划层面的因素对穆德种族/民族公平的贡献。第三，我们估计 旨在(A)改变提供系统改革的国家政策与(B)管理型医疗之间的联系 合同，以及穆德的股权。研究结果是Moud的任何用法和Moud的连续性，这两者都是 与降低死亡率有关。我们将使用地理空间分析、多层次建模和差异输入 通过差异分析来实现我们的特定目标。与州医疗补助官员的长期关系 允许我们直接与能够采取行动的政策制定者分享调查结果。MODRN有助于快速了解 从研究人员到政策制定者的转移，允许州医疗补助机构以其业绩为基准 在穆德对其他州的种族/民族平等，并支持国家机构相互学习 关于改善穆德公平的最有效的政策杠杆。

Abstract Access to medications for opioid use disorder (MOUD) is not equitable. Black and Hispanic individuals are substantially less likely to receive MOUD and other overdose prevention services. The overdose death rate has risen nearly twice as fast for Black individuals as for White individuals in recent years, a disparity that appears to have widened during the COVID-19 pandemic. Racial/ethnic inequities in receipt of MOUD are rooted in the structural racism ingrained in policies governing healthcare, housing, social services, criminal justice and other systems. As the largest single payer for MOUD and a key source of coverage for racial/ethnic minority groups, Medicaid is well-positioned to address inequities in MOUD. Although they have not done so to date, Medicaid agencies can adopt policies to alter (a) financial incentives for MOUD providers, and (b) contracts with managed care plans to improve equity in MOUD. Medicaid programs could institute requirements for provider networks; invest in building capacity for minority-serving Medicaid providers to deliver MOUD; include equity measures in provider performance measurement; and alter managed care contracts to incentivize plans to address inequities in MOUD. There is, however, little evidence on which of these levers is most likely to be effective. To inform Medicaid policy development, we harness the Medicaid Outcomes Distributed Research Network (MODRN), which is made up of university partnerships with Medicaid agencies in 11 states representing 22% of all US Medicaid enrollees. MODRN is currently funded by NIDA to study the quality of opioid use disorder treatment in Medicaid and has developed analytic infrastructure to conduct multi-state analyses of treatment with MOUD in Medicaid. We propose analyses that examine the role of place, providers, plans and policies in driving racial/ethnic inequities in MOUD. First, we examine racial/ethnic inequities in geographic access to MOUD providers among Medicaid enrollees. Second, we examine the contribution of provider- and plan-level factors to racial/ethnic equity in MOUD. Third, we estimate the association between state policies aimed at (a) changing delivery system reforms, and (b) managed care contracts, and equity in MOUD. Study outcomes are any use of MOUD and continuity of MOUD, both of which are associated with reduced mortality. We will use geospatial analyses, multi-level modeling, and difference-in difference analyses to accomplish our specific aims. Long-standing relationships with state Medicaid officials allow us to share findings directly with policymakers who can act on them. MODRN facilitates rapid knowledge transfer from researchers to policymakers, allows state Medicaid agencies to benchmark their performance on racial/ethnic equity in MOUD against other states, and supports state agencies learning from one another about the most effective policy levers for improving equity in MOUD.