Jenny Zhen-Duan1, Marie Fukuda2, Melissa DeJonckheere3, Irene Falgas-Bagué4, Steven Miyawaki5, Parwana Khazi6, Margarita Alegría7. 1. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA. Electronic address: jzhen-duan@mgh.harvard.edu. 2. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 3. Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. 4. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA. 5. Department of Sociology, Bowdoin College, Brunswick, ME, USA. 6. Department of Public Health, Santa Clara University, Santa Clara, CA, USA. 7. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Medicaid programs are vital to ensure low-income individuals have access to substance use disorder (SUD) treatment. However, shifts in Medicaid policies may alter coverage and SUD care for this population, who already face difficulties receiving high-quality SUD treatment. Using a policy implementation research approach, we sought to identify barriers and facilitators when transitioning from Medicaid fee-for-service to managed care plan structures and opportunities for improving SUD care in New York State (NYS). METHOD: Study staff conducted semistructured, in-depth qualitative interviews (N = 40 total) with diverse stakeholders involved with different aspects of SUD treatment in NYS, including policy leaders (n = 13), clinicians (n = 12), Medicaid managed care plan administrators (n = 5), and patients (n = 10). RESULTS: Findings from thematic analysis centered on three themes: 1) while transitions to managed care have benefited clinicians, certain policies affect patients' Medicaid enrollment and quality of care; 2) stakeholders perceived individuals with dual diagnoses, older adults, and linguistic minorities to be at higher risk for inadequate care; and 3) current quality metrics may not adequately capture treatment quality. CONCLUSION: Policy changes should focus on promoting increased collaboration among stakeholders, expanding Medicaid coverage, and reducing stigma. Resources should be diverted to facilitate psychiatric care for patients with dual diagnoses and to build workforce capacity to adequately meet the needs of older adults and linguistic minorities. Opportunities for NYS Medicaid include adapting performance metrics to capture meaningful patient outcomes and link reimbursements to improvements in patients' quality of life.
BACKGROUND: Medicaid programs are vital to ensure low-income individuals have access to substance use disorder (SUD) treatment. However, shifts in Medicaid policies may alter coverage and SUD care for this population, who already face difficulties receiving high-quality SUD treatment. Using a policy implementation research approach, we sought to identify barriers and facilitators when transitioning from Medicaid fee-for-service to managed care plan structures and opportunities for improving SUD care in New York State (NYS). METHOD: Study staff conducted semistructured, in-depth qualitative interviews (N = 40 total) with diverse stakeholders involved with different aspects of SUD treatment in NYS, including policy leaders (n = 13), clinicians (n = 12), Medicaid managed care plan administrators (n = 5), and patients (n = 10). RESULTS: Findings from thematic analysis centered on three themes: 1) while transitions to managed care have benefited clinicians, certain policies affect patients' Medicaid enrollment and quality of care; 2) stakeholders perceived individuals with dual diagnoses, older adults, and linguistic minorities to be at higher risk for inadequate care; and 3) current quality metrics may not adequately capture treatment quality. CONCLUSION: Policy changes should focus on promoting increased collaboration among stakeholders, expanding Medicaid coverage, and reducing stigma. Resources should be diverted to facilitate psychiatric care for patients with dual diagnoses and to build workforce capacity to adequately meet the needs of older adults and linguistic minorities. Opportunities for NYS Medicaid include adapting performance metrics to capture meaningful patient outcomes and link reimbursements to improvements in patients' quality of life.
Authors: Margarita Alegría; Irene Falgas-Bague; Marie Fukuda; Jenny Zhen-Duan; Cole Weaver; Isabel O'Malley; Timothy Layton; Jacob Wallace; Lulu Zhang; Sheri Markle; Charles Neighbors; Pat Lincourt; Shazia Hussain; Marc Manseau; Bradley D Stein; Nancy Rigotti; Sarah Wakeman; Martha Kane; A Eden Evins; Thomas McGuire Journal: JAMA Health Forum Date: 2022-07-01