Improving quality measurement for opioid use disorder treatment using a multi-state Medicaid research network

Medicaid covers the majority of individuals who need opioid use disorder (OUD) treatment. Improving OUD treatment quality in Medicaid thus can reach large numbers and improve health outcomes. State Medicaid programs have changed policy to expand the continuum of care and improve access to high-quality 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. 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 launch Examining 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 and incorporate patient experience. 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 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 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.