Examining opioid use disorder treatment in Medicaid managed care plans: policies and outcomes

美国继续与一场重大的阿片类药物危机作斗争。这是州医疗补助计划的一个关键问题 在医疗补助人群中，阿片类药物使用障碍(OUD)的比率几乎是 普通人口。近40%的OUD患者有医疗补助。对OUD的循证治疗， 包括FDA批准的三种药物，存在但未得到充分利用。访问和保留方面的障碍 治疗是众多和复杂的，包括污名、提供者能力和健康保险政策。 联邦和州政府管理医疗补助健康计划(MHPS)；然而，这些计划在 几个领域，包括覆盖、使用管理、网络管理、提供商支付和 创新政策。计划策略通过覆盖范围和提供商直接影响个人访问 提供服务的意愿，由于缺乏覆盖范围，使用管理带来的行政问题 要求和低付款率。尽管存在阿片类药物危机，但几乎没有任何信息或透明度 关于MHP与阿片类药物治疗服务相关的政策。 拟议的研究旨在系统地检查MHPS的OUD治疗的交付和管理，以及 做出重要决策的未充分开发的级别。我们将在全国范围内对MHPS和LINK进行调查 他们对国家医疗计划质量数据和来自三个州的患者级别医疗补助数据的回应 以检查结果。具体目标是： 目标1.描述医疗补助健康计划和治疗政策(例如，覆盖要求、利用率 管理、网络设计、支付和创新护理方法) 50个州和哥伦比亚特区，并确定相关的州政策、市场和计划特征 与OUD的治疗政策。 目的2.评估医疗补助计划的OUD治疗政策与计划水平的关系 参与者获得OUD治疗的比率和质量。 目的3.评估医疗补助计划的OUD治疗政策与患者水平的关系 OUD治疗的结果(如药物治疗持续时间、过量用药)。 研究小组是该项目的唯一合格人员，并将利用在之前的四个项目中开发的专业知识 NIDA和NIAAA资助的提供和管理行为健康的商业健康计划调查 服务和之前两项由NIDA资助的医疗补助研究。调查结果将提供关于以下方面的宝贵信息 在医疗补助计划下获得OUD治疗的机会和有效性。此信息可供计划使用 管理人员在制定和实施计划政策时，在与医疗补助主任签订合同和 监管MHPS和联邦政策制定者对医疗补助豁免和其他决定的使用 努力解决美国的OUD问题，帮助遏制OUD的浪潮及其往往致命的后果。

The United States continues to struggle with a major opioid crisis. This is a critical issue for state Medicaid programs as rates of opioid use disorders (OUD) in the Medicaid population are almost twice as high as the general population. Nearly 40% of people with OUD have Medicaid. Evidence-based treatments for OUD, including the three FDA-approved medications, exist but are underutilized. Barriers to access and retention in treatment are numerous and complex, including stigma, provider capacity and health insurance policies. Federal and state governments regulate Medicaid Health Plans (MHPs); however the plans have discretion in several areas including coverage, utilization management, network management, provider payment and innovative policies. Plan policies directly affect individual access both through coverage and through provider willingness to offer services, given lack of coverage, administrative headaches from utilization management requirements and low payment rates. Despite the opioid crisis, there is almost no information or transparency on MHP polices related to opioid treatment services. The proposed study aims to systematically examine delivery and management of OUD treatment in MHPs, an under-explored level where important decisions are made. We will conduct a national survey of MHPs and link their responses to national data on health plan quality and to patient-level Medicaid data from three states in order to examine outcomes. The specific aims are: Aim 1. Describe Medicaid health plan OUD treatment policies (e.g. coverage requirements, utilization management, network design, payment, and innovative care approaches) across MHPs that contract with 50 states and the District of Columbia and identify state policies, market and plan characteristics associated with OUD treatment policies. Aim 2. Evaluate the relationship between Medicaid health plans’ OUD treatment policies and plan-level rates of enrollee access to and quality of OUD treatment. Aim 3. Evaluate the relationship between Medicaid health plans’ OUD treatment policies and patient-level outcomes of OUD treatment (e.g. pharmacotherapy duration, overdose). The study team is uniquely qualified for this project and will leverage expertise developed in four previous NIDA and NIAAA-funded commercial health plan surveys of delivery and management of behavioral health services and 2 previous NIDA-funded Medicaid studies. Findings will provide valuable information regarding access to and effectiveness of OUD treatment under Medicaid plans. This information can be used by plan administrators as they develop and implement plan policies, state Medicaid directors as they contract with and regulate MHPs and federal policy makers making determinations about use of Medicaid waivers and other efforts to address OUD in the US, to help stem the tide of OUD and its often-deadly consequences.