Medicaid Managed Care Coverage and Utilization Management of Opioid Use Disorder Treatment

项目总结 随着国家继续与阿片类药物过量和死亡的快速变化的流行作斗争，有 越来越多的公众关注于扩大阿片使用障碍(OUD)治疗的机会。而当 医疗补助被定位为一个关键的政策杠杆，以改善获得OUD治疗的机会并降低死亡率 在弱势群体中，许多州的医疗补助计划并不涵盖所有的OUD 处理和使用可能限制访问的使用管理参数。此外，大多数州的医疗补助计划 计划与管理保健组织(MCO)签订合同。而超过70%的医疗补助参与者 参与MCO计划，对这些计划如何涵盖OUD治疗知之甚少。为了填补这一空白， 科学证据，我们将进行第一个关于医疗补助MCO覆盖范围和影响的多州研究 OUD治疗收据及结果使用管理设计。这项研究将通过以下方式开辟新天地 涵盖所有MCO计划，跨越多个州，进行完整的连续治疗。我们还建议 在两个州的医疗补助计划中利用创新的随机自动分配方法。我们的具体目标 将包括：评估州医疗补助计划合同法规和监督如何与 MCO计划层面的覆盖和使用设计；评估MCO如何计划覆盖和使用 管理设计与护理级联(诊断、参与、 药物启动和保留)；以及评估MCO如何计划覆盖和使用管理 参数与阿片类药物相关的急诊科就诊、住院和死亡率有关。 这项拟议的研究将是第一次全面调查MCO覆盖对OUD的影响 根据治疗收据和结果提供的治疗服务和药物--如果没有证据， 很大一部分乌尔德人的生活受到了威胁。这项研究还将对各州如何 正在规范和监测MCO计划的覆盖和使用管理设计。在这场战争中 美国历史上最致命的药物流行，关于医疗补助MCO覆盖范围的影响的证据 我们迫切需要治疗。这项研究将为政策制定者提供基于证据的指导 如何构建医疗保健合同安排，以确保适当和有效地获得OUD治疗。

PROJECT SUMMARY As the nation continues to grapple with a rapidly changing epidemic of opioid overdose and mortality, there has been increasing public attention devoted to expanding access to opioid use disorder (OUD) treatment. While Medicaid is positioned to be a key policy lever to improve access to OUD treatment and reduce mortality among vulnerable populations, many state Medicaid programs do not cover the full continuum of OUD treatment and use utilization management parameters that may restrict access. Moreover, most state Medicaid programs contract with managed care organizations (MCOs). While over 70% of all Medicaid enrollees participate in MCO plans, little is known about how these plans cover OUD treatment. To fill this gap in the scientific evidence, we will conduct the first multi-state study of the effects of Medicaid MCO coverage and utilization management design on OUD treatment receipt and outcomes. The study will break new ground by encompassing all MCO plans, across multiple states, for the full continuum of treatment. We also propose to make use of innovative random auto-assignment methods in two state Medicaid programs. Our specific aims will include: estimating how state Medicaid program contractual regulations and oversight are associated with MCO plan level coverage and utilization design; estimating how MCO plans’ coverage and utilization management design are associated with progression through the Cascade of Care (diagnosis, engagement, medication initiation, and retention); and estimating how MCO plans’ coverage and utilization management parameters are associated with opioid-related emergency department visits, hospitalizations, and mortality. The proposed study will be the first comprehensive investigation of the effects of MCO coverage for OUD treatment services and medications on treatment receipt and outcomes – evidence without which the care of a large fraction of the OUD population is compromised. The study will also produce new insight into how states are regulating and monitoring MCO plan coverage and utilization management design. In the midst of the deadliest drug epidemic in the nation’s history, evidence regarding the impact of Medicaid MCO coverage for OUD treatment is urgently needed. This research will equip policymakers with evidence-based guidance on how to structure MCO contractual arrangements to ensure appropriate and efficient access to OUD treatment.