Reducing variation in access to medications for opioid use disorder in Medicaid

Access to medications for opioid use disorder (MOUD) differs across the US based on where individuals live. Overdose deaths vary markedly by state of residence; urban and rural areas; and other measures of geography. As the largest single payer for MOUD, Medicaid is well-positioned to reduce variation in MOUD access and quality. Yet there exists substantial variation in receipt and duration of MOUD both between state Medicaid programs and within them across populations. Although they have not done so to date, Medicaid agencies can take several approaches reduce variation in MOUD access and quality. They can leverage financial incentives for MOUD providers and contracts with managed care organizations (MCOs) to reduce variation in treatment quality. They can institute requirements for provider networks; build the capacity for Medicaid providers to deliver MOUD; advance provider performance measurement; and incentivize MCOs to address barriers to care. There is, however, little evidence on which of these levers is most likely to be effective in improving access to MOUD and the quality of care delivered to Medicaid enrollees. To inform state Medicaid programs, we harness the Medicaid Outcomes Distributed Research Network (MODRN), which is made up of university partnerships with Medicaid agencies in 11 states representing 22% of all US Medicaid enrollees. We propose analyses that examine the role of place, providers, plans and policies in improving access to MOUD. First, we examine population subgroup differences in geographic access to MOUD providers among Medicaid enrollees. Second, we examine the contribution of provider- and MCO-level factors to variation in MOUD continuity. Third, we estimate the association between implementation of delivery system reforms and variation in MOUD. Study outcomes are any use of MOUD and continuity of MOUD, both of which are associated with reduced mortality. We will use geospatial analyses, multi-level modeling, and difference-in difference analyses to accomplish our specific aims. Long-standing relationships with state Medicaid officials allow us to share findings directly with policymakers who can act on them. MODRN facilitates rapid knowledge transfer from researchers to policymakers, allows state Medicaid agencies to benchmark their performance on access to and quality of MOUD treatment against other states, and supports state agencies learning from one another about the most effective policy levers for improving access to MOUD.