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着广泛的国家利益，这些模式旨在控制医疗保健支出的增长，并提高医疗保健的效率、协调和质量。2009年，马萨诸塞州蓝十字蓝盾公司（BCBSMA）建立了替代质量合同（AQC），该合同以一种类似于《平价医疗法案》授权的问责医疗组织（ACO）模式的方式，向供应商组织支付一笔带有绩效激励的全球付款。研究表明，在实施的最初一年，AQC与降低医疗保健总支出和提高医疗保健质量有关。目前还没有关于这类模式如何影响物质使用障碍（SUD）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，受到系统碎片化的困扰，其特点是初级保健的发现和治疗率低。只有一小部分AQC组织接受SUD处理费用的风险，AQC的效果可能因合同中包含SUD风险而有所不同。我们将比较AQC对SUD的效果和对尼古丁依赖的效果，尼古丁依赖不像SUD那样受到系统碎片化的影响，但在初级保健中的检出率和治疗率也很低。使用BCBSMA声明和2006-2011年的会员数据，对两个干预组（接受和不接受SUD风险的AQC组织中的参与者）和未参加AQC的参与者进行差异分析，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)在SUD和尼古丁依赖服务方面的支出；3)基于hedis的SUD治疗绩效指标。我们还将使用定性方法来探讨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对SUD和尼古丁依赖服务的使用、价格、支出和质量的看法。为了实现问责制医疗的目标，全国各地只实施了少数几种支付和交付系统模式。这项研究可以提供重要的新信息，以了解全球支付和责任医疗是否可以降低SUD的治疗率，并在不加剧避免治疗这一人群的动机的情况下改善SUD护理的协调和质量。

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.