The Impact of Health Homes in New York State on People with Substance Use Disorde

描述(由申请人提供)：通过医疗补助扩大医疗保险范围，将允许目前没有保险的人更多地获得SUD治疗。然而，各国将对费用控制感到关切，因为扩大覆盖范围将增加紧张预算的压力。健康之家(HHS)是联邦政府资助的医疗补助计划-由《平价医疗法案》授权-旨在提高护理质量，减少慢性医疗和行为疾病的浪费性支出。HHS的目标是在医疗补助覆盖的最脆弱人群中增加以患者为中心的护理。纽约(NY)已经获得联邦政府的批准，目前正在全州范围内推出HH计划(预计注册人数约为75万人)。NY HHS计划具有鲜明的特点，包括关注患有慢性医疗和精神健康障碍的参与者的SUD，在不同类型的提供者之间促进当地合作伙伴关系，以及使用护理经理来确保以患者为中心的护理。这项研究将使用纵向设计，研究纽约卫生保健计划是否提高了护理质量，减少了低效卫生保健，并降低了符合纽约卫生保健服务资格的12万名/年SUD患者的成本。2006年至2016年的行政数据将来自医疗补助申请和遭遇以及包括社会人口统计和物质使用数据在内的南加州登记记录的组合。研究将分两个阶段进行。在R21阶段(1年)，主要目标是通过与州机构建立书面协议、创建分析数据集和制定初始HH参与者的统计描述来建立研究基础设施。数据分析将包括使用描述性和混合效应逻辑回归分析来描述和对比子组(例如，符合条件但没有SUD的HH；患有SUD的高风险客户)的历史和基线社会人口、临床和医疗保健利用情况。在R33阶段(4年)，主要目标包括检查HHS是否改善了SUD治疗的医疗补助质量指标、SUD患者的医疗和精神健康护理质量、医疗保健效率(例如，可避免的再次住院)以及降低医疗补助成本。混合效应Logistic回归模型将在控制各种因素(例如，个别临床复杂因素)的同时，检查护理质量指标和成本的历史比率的变化。广义伽马模型将用于按年检查医疗补助成本。次要目标侧重于为HHS对结果的影响做出因果推断提供进一步的证据。回归分析将通过比较参与者和统计匹配的非参与者，检查护理管理者活动和结果之间的关联，以及主持人(例如，无家可归)和调解人(例如，初级保健参与度)与效率和成本之间的关联，来探索卫生保健计划与质量和成本之间的关系。随着其他州扩大医疗补助覆盖范围，并针对最昂贵和最有需要的人群对慢性病进行类似的改革努力，这些发现将具有相关性。

DESCRIPTION (provided by applicant): The expansion of healthcare coverage through Medicaid will allow greater access to SUD treatment among those who currently do not have coverage. However, States will be concerned about cost containment as expansion of coverage will increase pressures on strained budgets. Health Homes (HHs) are a federally funded Medicaid program-authorized by the Affordable Care Act-to improve quality of care and reduce wasteful spending for chronic medical and behavioral conditions. HHs aim to increase patient centered care among the most vulnerable populations covered under Medicaid. New York (NY) has received federal approval and is currently rolling out its HH program statewide (anticipated enrollment of about 750,000). The NY HHs program has distinct features including a focus on SUD among enrollees with chronic medical and mental health disorders, fostering of local partnerships among diverse types of providers, and use of care managers to ensure patient centered care. Using a longitudinal design, this study will examine whether the NY HH program improves quality of care, reduces inefficient healthcare, and lowers costs among the 120,000/year individuals with SUD who are eligible for HHs in NY. Administrative data from 2006 through 2016 will be derived from a combination of Medicaid claims and encounters and SUD state registry records which include socio- demographics and substance use data. The study will occur in two phases. In the R21 Phase (1 Year), Primary Aims focus on putting a research infrastructure in place by establishing written agreements with state agencies, creating analytical datasets, and developing a statistical description of initial HH enrollees. Data analysi will include using descriptive and mixed effects logistic regression analyses to describe and contrast historical and baseline socio-demographic, clinical and healthcare utilization among subgroups (e.g., HH eligible with no SUD; high risk clients with SUD). In the R33 Phase (4 years), Primary Aims include examining whether HHs improve Medicaid quality indicators of SUD treatment, quality of medical and mental health care among SUD clients, efficiency of healthcare (e.g., avoidable rehospitalizations), as well as reduce Medicaid costs. Mixed effects logistic regression models will examine changes from historical rates of quality of care metrics and of costs while controlling for a variety of factors (e.g., individual clinically complicating factors). Generalized gamma models will be used to examine Medicaid costs by year. Secondary Aims focus on providing further evidence for making causal inferences about the effect of HHs on outcomes. Regression analyses will explore the relationship between HH program and quality and costs by comparing enrollees to statistically matched non-enrollees, examining the association between care manager activity and outcomes, and the association between moderators (e.g., homelessness) and mediators (e.g., primary care engagement) with efficiency and costs. Findings will have relevance as other states expand Medicaid coverage and use similar reform efforts for chronic conditions targeting the costliest and neediest populations.