The Impact of Health Care Reform on Addiction and HIV Services

描述（由申请人提供）：卫生保健改革立法对获得服务和扩大物质使用障碍（SUD）患者，特别是艾滋病毒感染者的福利具有重大影响。这些情况与多种医疗和精神病合并症以及高医疗保健费用有关。响应RFA-DA-13-001，拟议的研究重点是将于2014年实施的《平价医疗法案》（ACA）的关键要素，该法案可能会增加对SUD和艾滋病毒治疗服务的需求。该研究评估了ACA对SUD患者在适合ACA实施研究的护理环境中的影响。凯泽北方加州（KPNC）是一个大型医疗保健系统，提供综合SUD和医疗服务，并已被指定为全州范围内的基准小团体计划在加州健康保险交易所。我们的创新方法是由组织理论和卫生服务利用的综合概念模型。在这项阶段性研究中，R21阶段的目标为分析会员人口统计学和临床复杂性，服务使用和成本的变化奠定了基础，使用了一个队列（n=3641）的新入组的前ACA健康计划成员SUD，包括SUD和HIV的成员。在R33阶段，我们使用前后设计比较R21队列与第二个ACA后队列（新入组的KPNC SUD成员），使用先进的差异中差异方法分析2014年开始的ACA相关变化。主要成果包括成员的变化，卫生服务的利用和成本，SUD治疗的启动和保留，以及艾滋病毒管理。ACA后队列也将在两年内进行纵向随访。通过创新的混合方法，我们使用来自健康计划广泛的电子病历的数据，并辅以与组织和临床领导者的定性访谈，内容涉及ACA相关的福利计划，服务交付，劳动力以及影响ACA实施的障碍或促进因素。调查结果将是高度翔实的了解健康计划如何实施ACA和服务于新投保的SUD和艾滋病毒患者人群，并将有助于未来的卫生政策。

DESCRIPTION (provided by applicant): Health care reform legislation has significant implications for access to services and expansion of benefits for those with substance use disorders (SUD), particularly those with HIV. These conditions are associated with multiple medical and psychiatric comorbidities as well as high health care costs. Responding to RFA-DA-13-001, the proposed study focuses on key elements of the Affordable Care Act (ACA) that will be implemented in 2014 and will likely increase demand for SUD and HIV treatment services. The study evaluates the impact of the ACA on individuals with SUDs in a care setting well-suited to ACA implementation research. Kaiser Permanente Northern California (KPNC) is a large health care system providing integrated SUD and medical treatment and has been designated as the statewide benchmark for small group plans in the California health insurance exchange. Our innovative approach is informed by an integrated conceptual model of organizational theory and health service utilization. In this phased study, the Aims of the R21 phase lay the groundwork for analyzing changes in membership demographics and clinical complexity, services use and costs, using a cohort (n=3641) of newly enrolled pre-ACA health plan members with SUDs, including members with both SUDs and HIV. In the R33 phase, we use a pre-post design to compare the R21 cohort to a second, post-ACA cohort of newly enrolled KPNC members with SUDs, using advanced difference-in-difference methods to analyze ACA-related changes that begin in 2014. Key outcomes include membership changes, health services utilization and costs, SUD treatment initiation and retention, and HIV management. The post- ACA cohort will also be followed longitudinally over two years. With an innovative mixed-methods approach, we use data from the health plan's extensive electronic medical record, supplemented by qualitative interviews with organizational and clinical leaders regarding ACA-related changes to benefit plans, service delivery, workforce, and barriers or facilitators that impact ACA implementation. Findings will be highly informative in understanding how health plans implement the ACA and serve newly insured SUD and HIV patient populations, and will contribute to future health policy.