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

美国继续与阿片类药物危机作斗争。这对州医疗补助计划来说是一个关键问题 由于医疗补助人群中阿片类药物使用障碍（OUD）的发生率几乎是医疗补助人群的两倍， 一般人口。近40%的OUD患者有医疗补助。OUD的循证治疗， 包括三种FDA批准的药物，存在但未得到充分利用。在获得和保留知识方面的障碍 治疗方法众多且复杂，包括污名化、提供者能力和医疗保险政策。 联邦和州政府对医疗补助计划（MHP）进行监管;但是，这些计划在以下方面有自由裁量权： 包括覆盖范围、使用管理、网络管理、提供商支付和 创新政策。计划政策通过承保范围和提供商直接影响个人访问 愿意提供服务，但缺乏覆盖面，利用率管理方面的行政难题 要求和低支付率。尽管存在阿片类药物危机，但几乎没有信息或透明度， 与阿片类药物治疗服务有关的MHP政策。 拟议的研究旨在系统地检查MHP中OUD治疗的提供和管理， 未被充分开发的层面，做出重要的决定。我们将对MHP进行全国性调查， 他们对健康计划质量的国家数据和来自三个州的患者水平医疗补助数据的反应， 为了检查结果。具体目标是： 目标1.描述Medicaid健康计划OUD治疗政策（例如，承保范围要求、利用率 管理，网络设计，支付和创新的护理方法）在与 50个州和哥伦比亚特区，并确定国家政策，市场和计划的特点相关联 治疗政策。 目标二。评估Medicaid健康计划的OUD治疗政策与计划水平之间的关系 OUD治疗的登记率和质量。 目标3。评估Medicaid健康计划的OUD治疗政策与患者水平之间的关系 OUD治疗的结局（例如药物治疗持续时间、用药过量）。 该研究小组是唯一有资格为这个项目，并将利用专业知识开发的四个以前 NIDA和NIAAA资助的商业健康计划对行为健康的提供和管理进行调查 服务和2个以前的NIDA资助的医疗补助研究。调查结果将提供有价值的信息， 根据医疗补助计划获得OUD治疗的机会和有效性。此信息可供计划使用 管理人员制定和实施计划政策时，州医疗补助主任与 规范MHP和联邦政策制定者对使用医疗补助豁免和其他 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.