Coaching Performance Driven Practice Change in the Context of Value Based Purchasing Under New York Medicaid

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Project Summary There is an urgent need for strategies to improve opioid use disorder (OUD) treatment quality: increase use of OUD medication, increase six-month retention rates, and improve recovery outcomes. In response, payers are transitioning to payment models that incentivize better performance on quality measures. However, most addictions treatment clinics are ill-equipped to become `learning systems' that can use quality measures to drive improvements in clinical care. Clinics are challenged by limited resources and a workforce that doesn't have the requisite experience or education in quality improvement methods. The New York State Medicaid program is an example of a payer transitioning to new reimbursement models that link payment to quality measures. Over the past three years, the New York State Office on Alcoholism and Substance Abuse Services (OASAS) has worked with the Center on Addiction to provide technical assistance for treatment clinics to ease the transition to new value-based payment models. After a series of stakeholder meetings involving health insurers and addictions programs, we concluded that clinics need: a) clinic-level performance measures that can guide quality management; b) coaching from external facilitators that help the leadership and direct service staff—with their limited background in management science—create quality driven organizations; and c) tools to guide direct service staff on patient-centered clinical care, specifically for shared decision making and monitoring of patient progress in care. Drawing from these experiences and available research, we have been developing new quality measures and strategies for assisting programs through clinical practice change that will inform this study. We propose to conduct a two phase study to address OUD treatment quality. The first phase will include a series of stakeholder meetings to get input on recommended quality measures, quality improvement strategies, provider support tools, and research strategies for a randomized trial. During this phase, intervention and research protocols for the trial will be finalized and electronic tools for providers will be developed. The second phase will include a stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2,000 OUD clients each year to test whether a clinic-level measurement-driven, quality improvement intervention (MDQI) will improve a) treatment process quality measures (use of OUD medications, in-treatment symptom and therapeutic progress, treatment retention) and b) recovery outcomes (substance use, health, and healthcare utilization).The intervention will use external facilitators to provide guidance to addictions clinics and contain three key components: 1) training on data driven management; 2) training and guidance on patient-centered care and OUD medication; and 3) electronic tools for shared decision making and patient progress monitoring. At the end of the project, we will have developed specific training and coaching protocols as well as electronic clinical support tools to guide quality improvement that can be disseminated within New York and the rest of the country.