Advancing quality of care for Medicaid enrollees in outpatient substance use disorder facilities - Project Summary/Abstract Ensuring access to high-quality outpatient substance use disorder (SUD) treatment is critical for addressing the overdose crisis, which has led to more than 600,000 deaths in the U.S. since 2018. As the largest payer of SUD services, Medicaid plays a central role in shaping SUD care delivery and financing. Most SUD treatment is delivered in outpatient facilities such as opioid treatment programs, community health centers, and specialty clinics, which vary considerably in their organizational (e.g., ownership, setting) and service delivery (e.g., modality, service offerings) characteristics. Little is known, however, about the quality of care delivered in these facilities. Accurate facility-level quality measurement is essential to guide improvement efforts, inform SUD payment models (e.g., pay-for-performance [P4P] models that link reimbursement to quality metrics), and enhance patient outcomes. The overall goal of this career development award is to implement a rigorous training and research plan that supports the applicant’s development as an independent SUD services researcher whose contributions lead to large-scale improvements in the quality of SUD care. Using a novel linkage between 2016-2024 Medicaid claims and SUD treatment facility datasets, the research aims of this award are to: 1) examine variation in care quality among outpatient SUD treatment facilities; 2) identify organizational and service delivery factors associated with high-quality SUD treatment; and 3) assess whether Medicaid P4P initiatives are associated with improved facility-level quality of care. The proposed research will be supported by mentoring from a multidisciplinary team of content and methodological experts, as well as didactic training in four areas: 1) management and analysis of complex datasets; 2) quality measurement methods; 3) financing and payment models in SUD care; and 4) causal inference methods. The proposed research and training goals are closely aligned with the National Institute on Drug Abuse (NIDA) priorities, including its Notice of Special Interest, Impact of Financing and Payment Mechanisms to Improve Behavioral Health Access, Utilization, and Outcomes (NOT-MH-24-270), and Priority Scientific Area #4, Improving the Implementation of Evidence-Based Strategies in Real-World Settings. Results from this study will advance claims-based, facility-level quality measurement, generating methodology and evidence that can be applied by providers and payers as part of their quality improvement efforts. Findings will also identify actionable organizational and financing factors associated with high-quality care, while contributing to the applicant’s development as an expert in SUD quality measurement and payment models. The training and research conducted under this award will lay the groundwork for a long-term, independently funded research program focused on advancing SUD quality measurement and applying these measures to evaluate quality improvement initiatives at the provider (e.g., organizational changes) and policy (e.g., P4P models) levels.
