Oregon's Coordinated Care Organizations Integrate Care for Drug Use Disorders

创新的俄勒冈州医疗计划(Medicaid)在医疗改革方面处于全国领先地位。州立法 (在两党支持下通过)授权协调护理组织(CCO)管理护理 医疗补助受助人。2012年5月，俄勒冈州获得了为期5年的19亿美元的联邦/州示范拨款，以 改革医疗保健和医疗保险和医疗补助服务中心批准了俄勒冈州的变化 健康计划2012年7月5日。8名CCOS于2012年8月1日开始，另外6名CCOS于2012年9月1日开始。俄勒冈州是一个 评估医疗改革对药物和酒精使用障碍治疗的影响的理想环境。 首席运营官在单一责任点(以患者为中心)中集成了身体和行为健康护理 初级疗养院)，以增加获得护理的机会，控制医疗成本和改善健康结果。 果断的预防和疾病管理服务寻求减少不必要的急救和住院 关心。全球预算和共享储蓄提高了医疗质量。一个主要目标是改善获得和 通过与初级保健相结合，利用酒精和药物使用障碍服务。 这项研究比较和对比了CCOS内成瘾治疗服务的整合情况。变化中的 对整合和融资战略进行了描述和编码，以评估与医疗保健利用的关联。 俄勒冈州All Payer All Claims(APAC)数据库提供了利用率和 允许计数a)筛查、b)咨询、c)酒精类处方药或 阿片类药物使用障碍，以及d)艾滋病毒快速检测。此外，亚太地区的数据记录了紧急访问 和住院病人入院。这项研究有三个具体目标。 具体目标1：第一年审查和编码批准的CCO申请，约谈CCO利益相关者以评估 A)行为健康综合战略，b)结果监测，c)重新设计行为健康系统 医疗保健，并选择8名CCO在2-5年间进行强化学习；8个学习地点为城市服务 和农村社区，并在融合和筹资战略方面各不相同。 具体目标2：从亚太地区的数据中提取利用率数据，a)比较CCO，b)跟踪 研究措施的支出和利用(例如，筛查、咨询、药物治疗处方 物质使用障碍、艾滋病毒快速检测)和结果(例如，使用急救和住院护理 有药物和酒精使用障碍诊断的个人)，以及c)评估支出之间的关系 药物和酒精服务的使用情况以及急诊和住院护理的支出和比率。 具体目标3：完成混合方法评估，包括定性评估(例如，关键信息提供人 访谈、观察)和量化数据(使用率和支出)，以确定个人、 与患者使用成瘾治疗服务相关的组织变量和背景变量 以初级疗养院为中心的。

The innovative Oregon Health Plan (Medicaid) is a national leader in healthcare reform. State legislation (passed with bipartisan support) authorized Coordinated Care Organizations (CCOs) to manage care for Medicaid recipients. In May 2012, Oregon received a five year $1.9 billion federal/state demonstration grant to transform care and the Centers for Medicare and Medicaid Services approved the changes in the Oregon Health Plan July 5, 2012. Eight CCOs began August 1, 2012 and six more September 1, 2012. Oregon is an ideal setting to assess the impact of healthcare reform on treatment for drug and alcohol use disorders. CCOs integrate physical and behavioral health care in a single point of accountability (a patient centered primary care home) to increase access to care, control healthcare costs and improve health outcomes. Assertive preventive and disease management services seek to reduce unnecessary emergency and hospital care. Global budgets and shared savings promote quality of care. A major goal is to improve access to and utilization of services for alcohol and drug use disorders through integration with primary care. The study compares and contrasts the integration of addiction treatment services within CCOs. Variations in integration and financing strategies are described and coded to assess associations with healthcare utilization. Oregons All Payer All Claims (APAC) database provides a comprehensive description of utilization and permits counts of the numbers of patients a) screened, b) counseled, c) prescribed medications for alcohol or opioid use disorders, and d) tested with HIV rapid testing. The APAC data, moreover, record emergency visits and inpatient admissions. The study has three specific aims. Specific Aim 1: Year 1review and code approved CCO applications, interview CCO stakeholders to assess a) behavioral health integration strategies, b) outcomes monitoring, and c) system redesign for behavioral healthcare, and select eight CCOs for intensive study during Years 2 through 5; the 8 study sites serve urban and rural communities and vary in integration and financing strategies. Specific Aim 2: Extract utilization data from the APAC data and a) compare CCOs, b) track change in spending and utilization on study measures (i.e., screening, counseling, pharmacotherapy prescriptions for substance use disorders, HIV rapid testing), and outcomes (i.e., use of emergency and inpatient care among individuals with diagnoses of drug and alcohol use disorders), and c) assess relationships between spending on and utilization of drug and alcohol services and expenditures for and rates of emergency and inpatient care. Specific Aim 3: Complete a mixed methods assessment integrating qualitative (e.g., key informant interviews, observations) and quantitative data (utilization rates and expenditures) to identify individual, organizational, and contextual variables associated with use of addiction treatment services in patient centered primary care homes.