Established under the Affordable Care Act, health homes (HHs) represent a major innovation in health service delivery for Medicaid beneficiaries with chronic health conditions, offering person-centered care coordination with a strong focus on behavioral health care and social supports and services. HHs have potential to improve receipt of addiction treatment and use and costs of acute care for addiction-related conditions (ARCs). However, research is needed to determine if HHs are successful in identifying and treating addiction, and if so, what practices are most effective in doing so. Strategies for identifying and treating addiction differ significantly across state HH models. The overall goal of this K01 application is to provide intensive, supervised career-development training to enable me to assess the impact of state HH model practices for identification and treatment of addiction on receipt of addiction treatment, and use and costs of acute care for ARCs. The proposed Mentored Research Scientist Development Award will allow me to supplement my expertise in health services research with advanced training in: econometrics, organizational theory, and survey design and administration. I will be guided by my primary mentor, John Brooks, PhD, and co-mentors Peter Friedmann, MD, MPH, Thomas D'Aunno, PhD, and Janice Probst, PhD. My training plan includes structured mentoring and study with Dr. Brooks, on use of econometric methods to estimate treatment effects using observational data, including use of propensity score matching and instrumental variable estimators; Dr. D'Aunno, on organizational theory; Dr. D'Aunno and Dr. Friedmann, on designing a pilot survey to measure addiction treatment integration and service coordination in HH provider organizations, and Dr. Probst, on effective management and construct measurement using complex public insurance claims data. I will also complete formal coursework in each of these areas. Drawing from Medicaid Analytic Extract (MAX) data from 2012-2014, I will use the knowledge and skills acquired through these training activities to: (1) examine the relationship of HH structure to the probability of addictio treatment receipt among Medicaid enrollees who participated in HHs during the period 2012-2014; (2) assess the effect of addiction treatment receipt on use and cost of acute care for ARCs among Medicaid enrollees participating in HH during the period 2012-2014; and (3) design and pilot a survey of organizational structures and practices employed by HHs to identify and treat addictive disorders. In sum, the proposed K01 Award will provide me with the resources, training, and mentoring needed to initiate my long-term independent research program to conduct research that can improve the capacity of HHs to identify and treat addiction.
This proposal responds to the National Institute on Drug Abuse's current strategic goal to 'to develop successful treatments for drug abuse and addiction and improve treatment accessibility.' The proposed research will yield policy-relevant evidence about the effectiveness of HH in increasing the accessibility of addiction treatment and reducing acute care for ARC on a national scale.