医疗补助管理护理组织对网络充足性的经验
Jane M Zhu1, Ruth Rowland2, Daniel Polsky3
1Division of General Internal Medicine, Oregon Health & Science University, Portland, OR 97239, United States.
Health affairs scholar
|April 7, 2025
概括
医疗补助管理护理计划在行为健康护理的网络充足性方面扎. 目前的法规错过了接入差距,计划需要更好的工具和以学生为中心的措施来改善接入.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 行为健康政策 行为健康政策
- 管理护理管理护理
背景情况:
- 获得行为健康护理对医疗补助计划的入学者来说是一个重大挑战.
- 管理护理组织 (MCO) 面临网络限制,影响护理可用性.
- 现有的网络充足性法规可能无法完全解决接入缺口.
研究的目的:
- 探索医疗补助管理护理组织 (MCO) 如何感知和响应行为健康护理的网络充足性标准.
- 在MCO中确定建立和监测适当的行为健康网络的障碍和促进者.
主要方法:
- 质量研究涉及采访27名管理人员和19个医疗补助MCO的高管.
- 目的性采样以达到最大的异质性,达到主题和.
- 代的诱导编码方法来分析采访数据.
主要成果:
- 当前的法规往往未能捕捉到行为健康护理的真正接入差距.
- 机组运营机构使用补充方法来监测网络充足性.
- 对于MCOs来说,他们可以采取有限的纠正措施来解决网络缺陷.
- 供应商目录的准确性受到后勤挑战的阻碍.
- 登记者的经验对于有意义的准入措施至关重要.
结论:
- 医疗补助计划中的行为健康护理现有的网络充足性规定存在缺陷.
- 有机会改善对MCO的监管支持,以加强网络充足性.
- 在修订法规时,政策制定者应该考虑入学者的经验和后勤障碍.
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