Substance Use Disorder Treatment under New Payment and Delivery System Models

描述（由申请人提供）：商业和公共部门医疗保健支付者对支付和提供医疗保健服务的新模式有广泛的国家利益，以控制医疗保健支出增长并提高效率，协调和护理质量。2009年，马萨诸塞州的蓝十字蓝盾（BCBSMA）建立了替代质量合同（AQC），该合同向提供者组织支付全球付款，并以类似于《平价医疗法案》授权的责任医疗组织（ACO）模式的方式提供绩效激励。研究表明，AQC与较低的总医疗保健支出和提高护理质量在其实施的第一年。没有关于这类模式如何影响对物质使用障碍的护理的信息，物质使用障碍被定义为非法药物和酒精滥用和依赖，这种疾病受到系统分散的困扰，其特点是初级保健中的发现率和治疗率低。只有一部分AQC组织接受SUD治疗费用的风险，AQC的影响可能因合同中是否包含SUD风险而异。我们将对比AQC实施对SUD的影响与尼古丁依赖的影响，尼古丁依赖是一种不受与SUD相同的系统碎片影响的疾病，但在初级保健中的检测和治疗率也很低。使用2006-2011年BCBSMA声明和会员数据进行差异中差异（DD）分析，比较两个干预组中的登记者-接受和不接受SUD风险的AQC组织中的登记者-与未参加AQC的登记者，我们将检查AQC对以下方面的影响：1）SUD和尼古丁依赖服务的使用和价格; 2）SUD和尼古丁依赖服务的支出;以及3）基于HEDIS的SUD治疗绩效指标。我们还将使用定性方法来探索AQC如何影响BCBSMA、AQC组织和专业SUD治疗机构的行政和临床领导层对SUD和尼古丁依赖服务的使用、价格、支出和质量的看法。在全国范围内，只有少数几个支付和提供系统模式被实施，以实现负责任护理的目标。这项研究可以产生关键的新信息，即全球支付和负责任的护理是否会降低SUD治疗不足的比率，并改善SUD护理的协调和质量，而不会加剧避免治疗这一人群的激励。

DESCRIPTION (provided by applicant): There is broad national interest among commercial and public sector health care payers in new models of paying for and delivering health care services in an effort to control health care spending growth and to improve the efficiency, coordination, and quality of care. In 2009, Blue Cross Blue Shield of Massachusetts (BCBSMA) established the Alternative Quality Contract (AQC), which pays provider organizations a global payment with performance incentives in a way that resembles accountable care organization (ACO) models authorized under the Affordable Care Act. Research indicates that the AQC was associated with lower total health care spending and improved quality of care in its initial year o implementation. No information is available on how this type of model affects care for substance use disorders (SUD), defined as illicit drug and alcohol abuse and dependence, conditions plagued by system fragmentation and characterized by low rates of detection and treatment in primary care. Only a subset of AQC organizations accepted risk for SUD treatment costs, and the AQC's effects may differ based on inclusion of SUD risk in the contract. We will contrast the effects of AQC implementation for SUD with effects for nicotine dependence, a condition not subject to the same system fragmentation as SUD but which also has low rates of detection and treatment in primary care. Using BCBSMA claims and membership data for 2006-2011 to conduct difference- in-differences (DD) analyses comparing enrollees in two intervention groups - those in AQC organizations that did and did not accept SUD risk - with enrollees not participating in the AQC, we will examine the AQC's effects on: 1) use and price of SUD and nicotine dependence services; 2) spending on SUD and nicotine dependence services; and 3) HEDIS-based performance measures for SUD treatment. We will also use qualitative methods to explore perceptions about how the AQC affects use, price, spending, and quality of SUD and nicotine dependence services among administrative and clinical leadership of BCBSMA, AQC organizations, and specialty SUD treatment facilities. Only a handful of payment and delivery system models have been implemented around the country to achieve the goals of accountable care. This study can produce critical new information about whether global payment and accountable care reduce rates of SUD under- treatment, and improve the coordination and quality of SUD care without exacerbating incentives to avoid treating this population.