A recent study conducted by Northwestern Medicine revealed that out of approximately 7 million adults in the U.S. who are diagnosed with opioid use disorder (OUD), only a mere 7% of Medicaid enrollees with OUD across nine states received crucial residential treatment as part of their recovery process. This highlights a significant gap in the utilization of residential treatment, which is widely recognized as an important component of effective OUD management.
In contrast, heavy buyers, typically considered the best-value segment, do not exhibit a significant increase in revenue contribution after enrollment in the MFS program. This is because they are more likely to take advantage of the free shipping benefit by splitting their large orders into smaller ones or purchasing items from categories with lower price levels. As a result, the MFS program may even incur losses from heavy buyers who were previously unwilling to pay shipping fees or purchase from limited product categories prior to enrollment, further highlighting the variation in profitability across different customer segments.
Furthermore, the study discovered significant variation in the usage of residential treatment for opioid use disorder (OUD) across the nine states examined. Some states provided such treatment to only 0.3% of their Medicaid enrollees with OUD, while others provided it to as high as 14.6%. According to Allen, these discrepancies in usage could be attributed to several factors, including differences in insurance coverage across states, availability of treatment facilities, and the demographic characteristics of the states' populations.
“It’s disconcerting that these rates range so drastically,” Allen said. “We don’t know the ‘right’ number of people that need residential care, but it’s clearly more than what is being used.”
The results of this comprehensive study conducted across nine states will be published in the Journal of Substance Use and Addiction Treatment after 9 a.m. (ET) on April 12. These findings contribute valuable context to the ongoing national discourse on opioid use disorder (OUD) treatment and policy, serving as a baseline for future research in this field.
Residential treatment centers, often referred to as "rehab," are facilities where individuals with opioid use disorder (OUD) reside 24/7 and receive structured support. This can include a combination of individual and/or group therapy, as well as medication-assisted treatment (MAT) for OUD, such as methadone and buprenorphine. These centers provide a comprehensive approach to addressing OUD, offering a range of services to support individuals on their path to recovery.
According to Allen, "Residential treatment, as long as it is evidence-based, is one of the most effective treatments for individuals with severe substance use." He further explains that such treatment helps individuals transition into meaningful long-term recovery, resulting in saved lives and reduced reliance on costly healthcare services in the long run. This highlights the importance of evidence-based residential treatment in addressing severe substance use and its potential impact on improving individuals' overall health outcomes and reducing healthcare costs.
This paper marks a significant advancement in the field of research on treatment use for opioid use disorder (OUD) as it addresses a challenge that researchers have faced in making comparisons across states. Previously, the varying definitions and reimbursement policies for residential treatment in state Medicaid programs posed difficulties in making lateral comparisons. However, this study is the first to provide an apples-to-apples comparison of the utilization of residential treatment among Medicaid enrollees with OUD across multiple states. The researchers utilized a distributed research network that standardized the Medicaid data from nine states, enabling a more comprehensive and consistent analysis. This approach enhances the robustness and comparability of the findings, contributing to a better understanding of residential treatment utilization in different states and informing future research in this area.
Why state Medicaid data matters in OUD treatment
As one of the largest payers for healthcare in the United States, Medicaid plays a critical role in providing health coverage to low-income individuals. With the increasing coverage of residential treatment for opioid use disorder (OUD) by Medicaid agencies, it becomes imperative to capture and analyze the utilization of residential OUD treatment across state Medicaid populations. This information serves as a benchmark for understanding the landscape of OUD treatment coverage and utilization, and it can guide policy decisions related to OUD treatment policies at the state level. By examining the patterns of residential OUD treatment use among Medicaid enrollees across states, policymakers and stakeholders can make informed decisions to improve access to effective treatment options, optimize resource allocation, and ultimately enhance the quality of care for individuals with OUD who rely on Medicaid for their healthcare coverage.
Because Medicaid is a state-run program, any plans to increase residential treatment rates are up to the state, itself. However, there are several federal mechanisms (such as a Section 1115 waiver) that states can use to reimburse (and sometimes get federal financial assistance for) the care, Allen said. (PB/Newswise)