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. 2022 Jul 1;3(7):e221771.
doi: 10.1001/jamahealthforum.2022.1771. eCollection 2022 Jul.

Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York

Margarita Alegría  1   2   3 , Irene Falgas-Bague  1   2 , Marie Fukuda  1 , Jenny Zhen-Duan  1   2 , Cole Weaver  4 , Isabel O'Malley  1 , Timothy Layton  4 , Jacob Wallace  5 , Lulu Zhang  1 , Sheri Markle  1 , Charles Neighbors  6   7 , Pat Lincourt  8 , Shazia Hussain  8 , Marc Manseau  6   9 , Bradley D Stein  10 , Nancy Rigotti  2   11   12 , Sarah Wakeman  2   13 , Martha Kane  3   14 , A Eden Evins  3   15 , Thomas McGuire  4
Affiliations

Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York

Margarita Alegría et al. JAMA Health Forum. .

Abstract

Importance: There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment.

Objective: To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment.

Design setting and participants: This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patterns, and outcomes among different types of MMC plans. Data from the latest years were received from the New York State Department of Health in October 2019, and analysis began soon thereafter. Approximately 17% did not make an active choice of plan, and a subset of these (approximately 4%) can be regarded as randomly assigned.

Exposures: Plan assignment.

Main outcomes and measures: Percentage of the enrollees achieving performance measures across 19 indicators of access, process, and outcomes of SUD treatment.

Results: Medicaid claims data from 159 016 adults (mean [SD] age, 35.9 [12.7] years; 74 261 women [46.7%]; 8746 [5.5%] Asian, 73 783 [46.4%] Black, and 40 549 [25.5%] White individuals) who were auto assigned to an MMC plan were analyzed. Consistent with national patterns, all plans achieved less than 50% (range, 0%-62.1%) on most performance measures. Across all plans, there were low levels of treatment engagement for alcohol (range, 0%-0.4%) and tobacco treatment (range, 0.8%-7.2%), except for engagement for opioid disorder treatment (range, 41.5%-61.4%). For access measures, 4 of the 9 plans performed significantly higher than the mean on recognition of an SUD diagnosis, any service use for the first time, and tobacco use screening. Of the process measures, total monthly expenditures on SUD treatment was the only measure for which plans differed significantly from the mean. Outcome measures differed little across plans.

Conclusions and relevance: The results of this cross-sectional study suggest the need for progress in engaging patients in SUD treatment and improvement in the low performance of SUD care and limited variation in MMC plans in New York, New York. Improvement in the overall performance of SUD treatment in Medicaid potentially depends on general program improvements, not moving recipients among plans.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Alegria, Falgas-Bague, and Rigotti and Ms Fukuda reported grants from National Institute on Drug Abuse (NIDA) during the conduct of the study. Ms O’Malley and Dr Stein reported grants from National Institutes of Health during the conduct of the study. Dr Layton reported personal fees from Greaylock McKinnon and Associates outside the submitted work. Dr Wallace reported grants from NIDA during the conduct of the study; additionally, his spouse is the Director of Medicaid Transformation and Financing at Aurrera Health Group. Dr Neighbors reported personal fees from Harvard University during the conduct of the study. Dr Wakeman reported personal fees from Celero Systems outside the submitted work. Dr Kane reported grants from the Health Resources and Services Administration outside the submitted work. No other disclosures were reported.

Comment in

  • doi: 10.1001/jamahealthforum.2022.1722

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