Outpatient follow-up and use of medications for opioid use disorder after residential treatment among Medicaid enrollees in 10 states

Abstract

Background: Follow-up after residential treatment is considered best practice in supporting patients with opioid use disorder (OUD) in their recovery. Yet, little is known about rates of follow-up after discharge. The objective of this analysis was to measure rates of follow-up and use of medications for OUD (MOUD) after residential treatment among Medicaid enrollees in 10 states, and to understand the enrollee and episode characteristics that are associated with both outcomes.

Methods: Using a distributed research network to analyze Medicaid claims data, we estimated the likelihood of 4 outcomes occurring within 7 and 30 days post-discharge from residential treatment for OUD using multinomial logit regression: no follow-up or MOUD, follow-up visit only, MOUD only, or both follow-up and MOUD. We used meta-analysis techniques to pool state-specific estimates into global estimates.

Results: We identified 90,639 episodes of residential treatment for OUD for 69,017 enrollees from 2018 to 2019. We found that 62.5% and 46.9% of episodes did not receive any follow-up or MOUD at 7 days and 30 days, respectively. In adjusted analyses, co-occurring mental health conditions, longer lengths of stay, prior receipt of MOUD or behavioral health counseling, and a recent ED visit for OUD were associated with a greater likelihood of receiving follow-up treatment including MOUD after discharge.

Conclusions: Forty-seven percent of residential treatment episodes for Medicaid enrollees are not followed by an outpatient visit or MOUD, and thus are not following best practices.

Keywords: Follow-up; Medicaid; Opioid use disorder; Residential treatment.

Figure 1:

Percent of Episodes with any follow-up within 30 days, by state between 2018 and 2019. This figure presents the percent of residential treatment episodes that included a MOUD fill, a follow-up visit, or both within 30 days of discharge, by state and in total across all states.

Figure 2:

Percent of episodes that included MOUD or behavioral health counseling within 30 days of admission into residential treatment, by state between 2018 and 2019.

Figure 3:

Meta-Analysis Forest Plots and Marginal Effects Estimating Outcomes at 30-Days Post-Discharge from Residential Treatment Note: Point estimates of adjusted marginal effects are presented in each table cell, with 95% confidence intervals in parentheses. Estimates can be interpreted as the percentage point change in the likelihood of the given outcome occurring. In the forest plots, 95% CIs are represented by the black lines, and the 90% prediction intervals are represented by the gray shaded bars. Other Race and Ethnicity includes all enrollees who are not non-Hispanic White. Non-disabled eligibility includes individuals enrolled through Medicaid expansion as well as other enrollees who are not disabled. LOS refers to the length of stay in days of the residential treatment episode. Subsequent episodes indicates whether the given episode was preceded by another residential treatment episode earlier in the study period. Previous 30 days refers to the 30 days before the first day of the residential treatment episode.

Figure 3:

Meta-Analysis Forest Plots and Marginal Effects Estimating Outcomes at 30-Days Post-Discharge from Residential Treatment Note: Point estimates of adjusted marginal effects are presented in each table cell, with 95% confidence intervals in parentheses. Estimates can be interpreted as the percentage point change in the likelihood of the given outcome occurring. In the forest plots, 95% CIs are represented by the black lines, and the 90% prediction intervals are represented by the gray shaded bars. Other Race and Ethnicity includes all enrollees who are not non-Hispanic White. Non-disabled eligibility includes individuals enrolled through Medicaid expansion as well as other enrollees who are not disabled. LOS refers to the length of stay in days of the residential treatment episode. Subsequent episodes indicates whether the given episode was preceded by another residential treatment episode earlier in the study period. Previous 30 days refers to the 30 days before the first day of the residential treatment episode.