Integrating Addiction Treatment and Medical Care in a Commercial Health Plan

描述(由申请人提供)：12个成瘾治疗中心和安泰行为健康公司合作，使用先进的康复系统改变模式，增加接受药物辅助治疗的酒精或阿片依赖患者的比例。成瘾治疗中心参与了一项为期22个月的系统改变策略的测试，以增加阿片类药物或酒精依赖患者获得药物的机会。该提案有三个具体目标：1)促进药物的采用；2)评估对医疗保健利用和支出的影响；3)进行定性访谈并记录实施障碍和变化战略。对安泰数据库的分析跟踪健康和行为健康服务的使用情况，以评估药物对护理利用率和成本的影响。具体目标1：运用制度变迁的超前康复模式，加快实施药物辅助治疗和医养结合；将12个戒毒中心指定为超前康复，并与12个匹配的对照点位进行比较。7H1a：在使用提前康复系统改变模式的中心，阿片类药物和酒精入院与成瘾药物处方一起入院的比例更大。7H1B：推进康复网站与更多的处方医生建立联系，并有更多的医生为患者开处方。具体目标2：使用安泰的使用和支出数据评估对住院、急救和住院护理的使用和支出的影响。7H2A：在参与推进康复的地点接受治疗的患者在住院医疗、紧急服务和住宅成瘾治疗方面的利用和支出将较低。7H2B：接受成瘾药物治疗的患者在住院医疗、急救服务和住宅成瘾治疗方面的利用和支出将较低。7H2C：连续开药较多的患者在住院医疗、急救服务和住宅成瘾治疗方面的利用和支出将较低。具体目标3：开展定性访谈，记录药物辅助治疗的实施障碍和有效实施策略。7H3A：提供商培训和态度是采用的障碍，而不是付款和报销问题。7H3B：没有丁丙诺啡经验的中心更有可能使用缓释纳曲酮治疗阿片依赖。

DESCRIPTION (provided by applicant): Twelve addiction treatment centers and Aetna Behavioral Health collaborate using the Advancing Recovery systems change model to increase the proportion of patients with medication-assisted treatment for alcohol or opioid dependence. The addiction treatment centers participate in a 22-month test of the system change strategy to enhance access to medication for patients dependent on opioids or alcohol. The proposal has three specific aims: 1) facilitate adoption of medications, 2) assess impacts on healthcare utilization and expenditures, and 3) conduct qualitative interviews and document implementation barriers and change strategies. Analyses of Aetna's databases track use of health and behavioral health services to assess medication impacts on the utilization and cost of care. Specific Aim 1: Use the Advancing Recovery model of system change to accelerate the implementation of medication-assisted treatment and integration with medical care; assign 12 addiction treatment centers to Advancing Recovery and compare to 12 matched comparison sites. 7 H1A: The proportion of opioid and alcohol admissions with prescriptions for addiction medications is greater in centers using the Advancing Recovery system change model. 7 H1B: Advancing Recovery sites form linkages with more prescribers and have more physicians writing prescriptions for patients. Specific Aim 2: Assess impacts on the utilization of and expenditures for inpatient, emergency and residential care using Aetna's utilization and expenditures data. 7 H2A: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients treated in sites participating in Advancing Recovery. 7 H2B: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients treated with addiction medications. 7 H2C: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients with more consecutive months of medication prescriptions. Specific Aim 3: Conduct qualitative interviews to document implementation barriers and effective implementation strategies for medication assisted treatment. 7 H3A: Provider training and attitudes are more problematic barriers to adoption than payment and reimbursement issues. 7 H3B: Centers with no experience with buprenorphine will be more likely to use extended release naltrexone for treatment of opioid dependence.