Policy Dissemination Strategies to Improve the Use of Research Evidence in Medicaid Benefits for Opioid Use Disorder Treatment - PROJECT SUMMARY/ABSTRACT
The purpose of this proposed K01 Mentored Research Career Development Award is to support the applicant
in advancing and maximizing her research skills in order to launch an independent research career in the
dissemination and implementation of evidence-based substance use treatment for safety net populations. Safety
net populations, especially individuals who are publicly insured by Medicaid and the Children’s Health Insurance
Program (CHIP), have been disproportionately impacted by the U.S. opioid epidemic. Despite a significant need
for treatment, lifesaving medications for opioid use disorder (MOUD) are underused by this population. Low
MOUD use is driven by a myriad of misaligned federal, state, Medicaid/CHIP agency and managed care
organization benefit and utilization management policies informed by varying levels of evidence. Federal policy
requires all three MOUD (i.e., buprenorphine, methadone, naltrexone) be included as mandatory Medicaid state
plan benefits, but not all states have complied, and the Centers for Medicare and Medicaid Services
acknowledges that enforcing coverage is not feasible. Even when Medicaid/CHIP agencies cover all three
MOUD, they can restrict access via preferred drug lists, fail-first, prior and re-authorization requirements – thus
imposing potentially life-threatening care delays on beneficiaries. Managed care organizations (MCOs) that
many state agencies contract to administer benefits can enact additional utilization management policies that
limit MOUD access. Research is needed to promote Medicaid/CHIP and MCO policymakers’ use of scientific
evidence when designing MOUD benefits. Under the mentorship of Dr. Gregory Aarons (sponsor and mentor)
and an expert mentoring team, the applicant will pursue training in: (1) survey design, (2) multivariate statistical
analysis, including latent class analysis and finite mixture modeling, (3) policy dissemination strategy
development, including packaging and communicating evidence for policymakers, and (4) developing research
partnerships with policy-relevant decision-makers. These training goals will facilitate accomplishing research
aims to: (1) develop and administer a national survey to Medicaid/CHIP agency and MCO policymakers to
identify determinants, mechanisms, and intermediaries that influence their evidence use behaviors; (2)
empirically identify and describe distinct subgroups of Medicaid/CHIP agencies and MCOs based on their
evidence use behaviors when designing MOUD benefits; (3) design and pilot test the acceptability,
appropriateness and feasibility of dissemination strategies, tailored to each latent class, for promoting
policymakers’ evidence-based decision-making regarding MOUD benefits. This proposal is aligned with NIDA’s
strategic objectives to assess the impact of substance use disorder-related federal, state and systems policies
on public health, and to identify strategic intermediaries and policy implementation strategies aimed at improving
evidence use in policy. The planned K01 activities will effectively position the applicant to achieve an independent
research career focused on improving access to evidence-based substance use treatment.
