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纽约州行为健康系统向医疗补助管理式医疗过渡的准备情况评估

An Assessment of The New York State Behavioral Health System's Readiness to Transition to Medicaid Managed Care.

机构信息

McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th floor, New York, NY, 10003, USA.

出版信息

Community Ment Health J. 2019 May;55(4):599-607. doi: 10.1007/s10597-019-00369-w. Epub 2019 Jan 30.

Abstract

New York State has one of the most richly funded Medicaid programs in the United States. In an effort to achieve the triple aim New York State is undergoing a significant redesign of its Medicaid program including transitioning nearly all Medicaid funded behavioral health services into Medicaid managed care. In preparation for this transition, a state funded technical assistance center assessed the behavioral health care system's readiness to undergo this reform across 11 domains. Between September and November, 2014, the TA center electronically distributed a readiness survey to 897 mental health and substance abuse agencies: 313 (n = 269, 33%) organizations completed the assessment. As a whole, the sample felt partially ready to transition; analysis by domain revealed agencies were most ready to interface with managed care providers, and least ready to collect and evaluate outcome data. Significant differences in readiness were found depending by organizational characteristics (number of programs, licensure, and region). In anticipation of large-scale reforms, states would benefit from an initial needs assessment to identify gaps in knowledge and skills, which in turn, can then guide preparatory efforts and provide needed supports to facilitate major changes in service delivery and billing.

摘要

纽约州拥有美国资金最充足的医疗补助计划之一。为了实现三重目标,纽约州正在对其医疗补助计划进行重大重新设计,包括将几乎所有由医疗补助资助的行为健康服务转为医疗补助管理式医疗。在为这次过渡做准备的过程中,一个由州政府资助的技术援助中心在 11 个领域评估了行为健康护理系统为进行这次改革所做好的准备。2014 年 9 月至 11 月,TA 中心以电子方式向 897 家精神卫生和药物滥用机构分发了一份准备情况调查:313 家(n=269,33%)机构完成了评估。总体而言,样本机构认为自己已经部分做好了过渡准备;按领域分析显示,各机构最有准备与管理式医疗服务提供商对接,而最不准备收集和评估结果数据。不同的组织特征(项目数量、许可和地区)导致了准备情况的显著差异。为了迎接大规模改革,各州将受益于进行初步需求评估,以确定知识和技能方面的差距,这反过来又可以指导筹备工作,并提供必要的支持,以促进服务提供和计费方面的重大变革。

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