The relationship between social needs and primary care use after enrollment in Virginia’s Medicaid expansion: The influence of sociocultural and built environments

项目摘要。医疗补助计划的扩大是一个重要的反贫困工具，保护个人免受医疗保健 成本和减少粮食和住房不安全，这是造成健康状况不佳和健康差距的重要因素。 医疗补助的扩大增加了获得初级保健的机会，这是一种假设的机制， 对低收入个人的保险覆盖减少了社会需求。然而，社会需求和获得 初级保健受到社会文化和建筑环境以及保健系统供应的影响。 本研究应用NIMHD的研究框架，以了解这些影响领域如何 在有或没有社会需求的人群中，有区别地塑造获得初级保健的机会， 可能的机制，其中医疗补助扩大减少粮食和住房不安全，初级保健的使用。 这项工作将利用完善的州立大学合作伙伴关系和独特的数据集，包括 弗吉尼亚州新注册的医疗补助扩展成员的经验。以下现有数据将 本研究通过Medicaid成员识别号链接：1）招募前调查，询问成员 关于他们在医疗补助扩大注册前一年的经历（n= 1，255），2）随访调查 询问成员入组后一年内的经历（n=580），3）所有遭遇和药房索赔 这些弗吉尼亚州医疗补助计划成员的数据，以及4）公开的社会文化措施，建立了 环境和卫生保健系统的影响领域与成员的人口普查区或县有关。的 拟议的研究得到了弗吉尼亚州医疗补助计划的支持，因为它符合该机构的承诺， 通过增加初级保健和减少社会需求实现保健公平。这项拟议工作的目的是：1） 评估社会文化环境、建筑环境和卫生保健系统领域如何改变 在医疗补助计划扩大注册前一年， 2）探索初级保健的利用是否减少了入学后的食物和住房不安全 医疗补助计划扩大的第一年。最终，这项工作将提供急需的证据， 决策者了解社会文化和建筑环境因素在获得初级保健方面的差异 并提供有关医疗补助扩张如何减少社会需求的见解。满足社会需求 通过卫生保健政策和初级保健系统设计将改善人口健康， 实现卫生公平。该应用程序描述了一个优秀的研究和培训环境， 建议的工作，由一个合作的导师团队，包括教师和弗吉尼亚州的支持 医疗补助的首席医疗官。该提案将提供综合的，强大的临床和研究培训， 健康差距，卫生政策和地理空间统计，以医生，科学家致力于实践家庭 医学和追求一个教师的位置，重点是通过卫生政策促进健康公平。

Project Abstract. Medicaid expansion is a critical antipoverty tool that protects individuals from health care costs and reduces food and housing insecurity, significant contributors to poor health and health disparities. Medicaid expansion increases access to primary care, a hypothesized mechanism by which this public insurance coverage for low-income individuals reduces social needs. However, social needs and access to primary care are influenced by the sociocultural and built environments as well as health care system supply. This study applies the NIMHD’s Research Framework to understand how these domains of influence differentially shape access to primary care across those with or without social needs and in turn explores a possible mechanism in which Medicaid expansion reduces food and housing insecurity, primary care use. This work will leverage a well-established state-university partnership and unique data set consisting of the experiences of newly enrolled Medicaid expansion members in Virginia. The following existing data will be linked for this study by Medicaid member identification number: 1) pre-enrollment surveys asking members about their experiences in the year prior to Medicaid expansion enrollment (n=1,255), 2) a follow-up survey asking members about experiences in the year after enrollment (n=580), 3) all encounter and pharmacy claims data for these same Virginia Medicaid members, and 4) publicly-available measures of sociocultural, built environment, and health care system domains of influence linked to members’ census tracts or counties. The proposed research is supported by Virginia Medicaid as it aligns with the agency’s commitment to advance health equity through increasing primary care and reducing social needs. This proposed work aims to: 1) Assess how sociocultural environment, built environment, and health care system domains modify the effect of food and housing insecurity in the year prior to Medicaid expansion enrollment on primary care utilization in the year after enrollment, and 2) Explore whether primary care utilization reduces food and housing insecurity after the first year of enrollment in Medicaid expansion. Ultimately this work will provide much needed evidence to policymakers about the disparities in access to primary care across sociocultural and built environment factors as well as provide insight into how Medicaid expansion is reducing social needs. Addressing social needs through health care policies and primary care system design will improve population health and is necessary to achieve health equity. This application describes an excellent research and training environment for the proposed work, supported by a collaborative mentorship team that includes both faculty members and Virginia Medicaid’s Chief Medical Officer. This proposal will provide integrated, robust clinical and research training in health disparities, health policy, and geospatial statistics to a physician-scientist dedicated to practicing family medicine and pursuing a faculty position focused on advancing health equity through health policy.