Treatment for opioid use disorder in the Florida medicaid population: Using a cascade of care model to evaluate quality

ABSTRACT

Background: A cascade of care (CoC) model may improve understanding of gaps in addiction treatment availability and quality over current single measure methods. Despite increased funding, opioid overdose rates remain high. Therefore, it is critical to understand where the health-care system is failing to provide appropriate care for people with opioid use disorder (OUD) diagnoses, and to assess disparities in receipt of medication for OUD (MOUD).

Objective: Using a CoC framework, assess treatment quality and outcomes for OUD in the Florida Medicaid population in 2017/2018 by demographics and primary vs. secondary diagnosis.

Methods: Data from Florida Medicaid claims for 2017 and 2018 were used to calculate the number of enrollees who were diagnosed, began MOUD, were retained on medication for a minimum of 180 days, and who died.

Results: Only 28% of those diagnosed with OUD began treatment with an FDA approved MOUD (buprenorphine, methadone, or injectable naltrexone). Once on medication, 38% of newly diagnosed enrollees were retained in treatment for180 days. Those who remained on MOUD for 180 days had a hazard ratio of death of 0.226 (95% CI = 0.174 to 0.294) compared to those that did not initiate MOUD, a reduction in mortality from 10% without MOUD to 2% with MOUD.

Conclusions: Initiating medication after OUD diagnosis offers the greatest opportunity for intervention to reduce overdose deaths, though efforts to increase retention are also warranted. Analyzing claims data with CoC identifies system functioning for specific populations, and suggests policies and clinical pathways to target for improvement.

KEYWORDS:

• Opioids
• addiction treatment
• treatment quality
• cascade of care
• treatment access

Additional information

Funding

We thank the National Institute on Drug Abuse (NIDA) for support for this paper through grants [R01DA037222-05S1] (McGovern PI; McGovern and Brown, effort), [P30 DA027828] (Brown PI; Brown effort), and the National Center for Advancing Translational Sciences, (NCATS) grant [UL1TR001422] (Lloyd-Jones PI, Brown effort), and the Florida Agency for Health Care Administration contract (Florida Medicaid Drug Therapy Management Program For Behavioral Health, data for analysis). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.