Improving quality and equity of opioid use disorder treatment using a multi-state Medicaid research network

Project Summary Medicaid covers the majority of individuals who need opioid use disorder (OUD) treatment and disproportionately covers minoritized populations and those with socioeconomic risk factors. Improving OUD treatment quality in Medicaid thus can reach large numbers and inform efforts to redress inequities in care.

State Medicaid programs have changed policy to expand the continuum of care, remove barriers to treatment, and improve the quality of OUD care. However, states have taken these actions amidst OUD quality measurement systems that are underdeveloped limiting opportunities for targeted intervention and robust

evaluation of policy effects. Current OUD quality measures are limited in three key ways. First, OUD quality measures are seldom constructed at the provider-level, despite the fact that clinicians, practices, and facilities are the most likely locus of intervention for quality improvement programs. Second, few measures incorporate

OUD patient-reported outcomes or experiences of care. Third, quality measures are typically not reported by population sub-group and thus fail to identify inequities in treatment based on race and ethnicity amenable to policy and programmatic changes. The Medicaid Outcomes Distributed Research Network (MODRN) has supported Medicaid agency efforts to

improve OUD treatment by developing novel measures of treatment quality and examining effects of treatment quality on overdose. MODRN will develop Equity and QUality Improvement for Medicaid Programs (EQUIP) and draw on our robust university-state partnerships in 12 states accounting for 24% of the US

Medicaid population. Our overarching goal is to develop OUD quality measures that can be constructed at the provider-level, incorporate patient experience, and center health equity. Efficient and sustainable OUD quality measures developed and implemented by MODRN-EQUIP will guide quality improvement initiatives and

Medicaid policy decisions. Our goal will be achieved through three integrated research projects aiming to: 1) develop provider-level OUD quality measures using Medicaid administrative data; 2) measure OUD patient- reported outcomes and examine associations with claims-based quality measures to guide quality and equity

improvement, and 3) implement and examine the effectiveness of a practice-level quality improvement intervention for OUD. A State Steering Committee of Medicaid leaders will oversee MODRN-EQUIP, drawing on infrastructure supported by prior NIDA grants (R01DA055585 and R01DA048029). These research projects will be executed

by a Coordinating Center, a Methods Core and an Engagement and Dissemination Core that draws on the expertise of Medicaid beneficiaries, providers, managed care organizations and policymakers to develop quality measurement and management systems to transform substance use treatment. We will disseminate

our findings through state policy networks to reach beyond our 12 states to other Medicaid programs.