Improving value-based healthcare delivery for opioid use disorder

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Project Summary Opioid use disorder (OUD) is an increasingly common cause of death, disability, and cost to the healthcare system. Though evidence-based OUD treatment exists, uptake is often poor; and those with OUD frequently have profound health-related social needs that complicate their care. Improving OUD outcomes depends not only on treatment efficacy, but also on optimizing the healthcare delivery and payment systems in which efficacious treatments are deployed. Value-based care – a healthcare delivery and payment model that aims to incentivize value rather than volume of care – represents a widespread approach to healthcare reform touted for its potential to improve OUD care processes and outcomes. Despite this promise, however, large knowledge gaps remain in our understanding of whether – and how – value-based care may promote quality care for people with OUD. This K01 proposal therefore leverages an opportunity to assess the effectiveness of value-based care delivery for OUD in the context of Massachusetts’ implementation of an innovative new Medicaid accountable care organization (ACO) model of care. The Massachusetts Medicaid ACO program is the first of its kind to base ACO payments not only on beneficiaries’ medical complexity, but also on behavioral health and social complexity. The research aims are to use implementation of this novel ACO program as a natural experiment to 1) assess the impact of value-based care reform on OUD care quality, 2) understand whether current risk adjustment methods for setting ACO payments adequately cover costs of care for socially complex patients with OUD and housing instability, and 3) develop a pilot risk adjustment model for OUD care quality measures. The Principal Investigator, Dr. Heather Hsu, is an early career clinician-investigator with prior research experience at the intersection of infectious disease epidemiology, health services research, and value-based care. With this K01, she seeks to transition the clinical focus of her research to substance use, focusing on developing content expertise in addiction healthcare delivery and advanced methodologic skills in quasi-experimental study design and risk adjustment for quality and payment. Dr. Hsu will acquire these skills and conduct the proposed research at Boston Medical Center and Boston University School of Medicine, national leaders in addiction medicine and research and home to the largest group of Medicaid ACOs in Massachusetts. The proposal is supported by an interdisciplinary mentorship and advisory team with expertise in addiction medicine, substance use research, social determinants of health, advanced methods for causal inference, health economics, econometrics, and risk adjustment. Training will be accomplished through an intensive combination of formal coursework, workshops, field experience, applied research experience, guided tutorials, and focused mentorship. At the end of the K01 award period, Dr. Hsu will be well-positioned to accomplish her long-term goal to become an independent investigator and expert on improving value-based healthcare delivery to persons with substance use disorders.