Patient experiences with outpatient opioid use disorder treatment before and during COVID-19: results from a survey of Medicaid members

ABSTRACT

Background: Payers are increasingly interested in quality improvement for opioid use disorder (OUD) treatment, including incorporating patient experiences. Medicaid is the largest payer for OUD treatment, yet we know little about the treatment benefits Medicaid members report, how these vary across members, or changed with the COVID-19 pandemic.

Objective: To examine Medicaid members’ report of outpatient treatment benefits, employment, and housing outcomes before and during the pandemic.

Methods: A representative sample of 1,032 Virginia Medicaid members (52% women) receiving OUD treatment completed a survey of treatment benefits, health status and social needs. A reported treatment benefit index was created based on seven self-reported items. Multivariable linear regression models, pooled and stratified by time (pre-COVID-19/COVID-19), assessed member characteristics associated with reported treatment benefit, employment and housing outcomes.

Results: Members reported strong treatment benefit (mean: 21.8 [SD: 5.9] out of 28 points) and improvements in employment (2.4 [1.3] out of 5) and housing (2.8 [1.2] out of 5). After adjustment, mental distress (regression coefficient: −3.00 [95% CI:-3.97;-2.03]), polysubstance use (−1.25 [−1.99;-0.51]), and food insecurity (−1.00 [−1.71;-0.29]), were associated with decreased benefits from treatment. During COVID-19, justice-involved individuals reported decreased benefits (−2.17 [−3.54; −0.80]) compared to before the pandemic (−0.09 [−1.4-;1.24] p < .05).

Conclusions: Medicaid members receiving outpatient OUD treatment reported positive treatment benefits, and housing and employment outcomes. However, those with comorbid health and social conditions often benefited the least. As payers move toward quality improvement and value-based purchasing initiatives, collecting and integrating patient reported outcomes into quality metrics is critical.

KEYWORDS:

• Patient surveys
• quality assessment
• quality of life
• substance use disorder
• Medicaid

Acknowledgments

The authors would like to thank the participants for sharing their treatment experiences with us. The authors are also grateful to the Virginia Department of Medical Assistance Services for providing their technical expertise on Virginia Medicaid’s substance use treatment benefits and services.

Disclosure statement

Drs. McCray, Palazzolo, Bachireddy, Ms. Harrell, and Mr. Lowe report employment by the Virginia Department of Medical Assistance Services. Ms. Marks, Ms. Guerra, Drs. Barnes, Cunningham, and Pham report funding from the Virginia Department of Medical Assistance Services. Drs Barnes and Cunningham report funding from the Center for Medicare and Medicaid Services. Drs. Barnes, Cunningham, and Pham report funding from the NIH. Dr. Barnes reports funding from the Urban Institute. Dr. Cunningham reports funding from the Jeffress Memorial and Trust.

Additional information

Funding

Financial support for this work was provided by the U.S. Centers for Medicare and Medicaid Services and the Virginia Department of Medical Assistance Services (IAG No. 407, Appendix K) as part of the Addiction and Recovery Treatment Services 1115 waiver evaluation and the Substance Use Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act: Section 1003 Demonstration Project to Increase Substance Use Provider Capacity. The conclusions in this manuscript are those of the authors, and no official endorsement by the Virginia Department of Medical Assistance Services is intended or should be inferred.