Most States Already Collect Data That Can Help Improve Opioid Use Disorder Treatment
When used to inform policy, this information can increase access to care, save lives
Methadone, buprenorphine, and naltrexone—the three Food and Drug Administration-approved medications for opioid use disorder (OUD)—are critical to curbing the opioid crisis and reducing overdose deaths. However, most people with OUD do not receive these lifesaving medications.
State officials can increase access to such care by applying a set of core OUD treatment measures that help them assess the effectiveness of their OUD treatment systems and make data-driven policy decisions to improve outcomes. These measures are based on the “cascade of care” public health framework that tracks data on OUD treatment through stages ranging from diagnosis to recovery.
Pew recommends that state officials not only collect data on the measures but also make it publicly available “to create accountability on the effectiveness of the state’s efforts to address the opioid crisis.” Such public reporting of clinical measures has been associated with improving health outcomes. Currently, most of the core OUD treatment measures are included in the federal reporting requirements for at least one Medicaid program. (See Table 1.) The programs were identified based on conversations with Centers for Medicare & Medicaid Services (CMS) staff and include the following:
- The behavioral health core set evaluates the quality of behavioral health services delivered in the Medicaid program. Reporting these measures was optional at the time of this analysis but became mandatory Oct. 1, at the start of federal fiscal year 2024.
- 1115 substance use disorder (SUD) waivers pay for residential treatment at facilities that provide services through the Medicaid program for people with a behavioral health condition.
- Medicaid health homes provide coordinated treatment for people with complex conditions such as OUD.
Table 1
The Core OUD Treatment Measures and Federal Medicaid Reporting Requirements
| Measure | Behavioral health core set | 1115 SUD waiver | Health homes |
|---|---|---|---|
| OUD diagnosis
Percentage of people with a recorded OUD diagnosis |
⚫ | ||
| Assessed for SUD using a standardized screening tool
Percentage of people who were administered an established SUD screening tool |
⚫ | ||
| Use of pharmacotherapy for OUD*
Percentage of people with OUD who were treated with medication |
⚫ | ⚫ | |
| OUD provider availability
Number of providers and treatment programs that prescribe medication for OUD |
⚫ | ||
| Continuity of pharmacotherapy for OUD†
Percentage of people who received OUD for at least six months |
⚫ | ||
| Initiation of OUD treatment and engagement in OUD treatment‡
Percentage of people who initiate treatment within two weeks of diagnosis; percentage of people with two or more services within the first month after initiating treatment |
⚫ | ⚫ | ⚫ |
| Follow-up after an emergency department visit for substance use§
Percentage of people who receive follow-up care for SUD or an overdose within seven days, and 30 days after visiting an emergency department for a substance use disorder-related issue |
⚫ | ⚫ | ⚫ |
| One or more patient-reported outcome measures to be determined by each state
Recovery-related measures |
N/A** | N/A | N/A |
|
Note: While states reporting the measures related to behavioral health and the 1115 waiver report the data for the entire enrolled Medicaid population, the health homes measures are applicable only to enrollees participating in those programs.
* Use of pharmacotherapy for OUD refers to the National Committee for Quality Assurance (NCQA) National Quality Forum (NQF) measure 3400. |
Many states already report the measures, but some are more commonly shared
Most states reported on at least one core OUD treatment measure, specifically:
- 49 reported on follow-up care for people with SUD who had an emergency department visit.
- 47 reported on initiating and engaging in OUD treatment after diagnosis to understand whether people received treatment.
The least reported measure was assessing for SUD using a standardized screening tool. Only two states reported this measure, which is crucial for understanding whether states can identify people with a SUD who need treatment, inform how to improve the screening process, and ensure that screening is available across a variety of settings.
Notes: Although both Montana and Massachusetts have approved 1115 SUD waivers, they did not have associated monitoring plans available for review and may be reporting more measures than listed. A detailed breakdown of specific core OUD treatment measures reported by state through CMS programs can be found in the data download. The information presented in the maps is current as of the dates specified in the Excel file, which range from 2019 to 2023. Data from the behavioral health core set and health home programs are current as of federal fiscal year 2020, and data from 1115 SUD waivers are current as of the dates specified in the Excel file, which range from 2019 to 2023. A state is counted as reporting a measure if it does so through any of the CMS programs that include the measure. For example, because use of pharmacotherapy for OUD can be found in the behavioral health core set and the health homes program, a state is counted as reporting the measure if it is reported in either program. As such, the number of measures a state reports is influenced by the specific programs in which it participates.
Some states are reporting most of the measures available through CMS programs
The more measures that states collect and report, the more fully they can assess and improve their treatment system’s ability to respond to the needs of people with OUD across a spectrum of services from screening and diagnosis to recovery. The number of measures each state reports through CMS programs ranged from all seven measures in West Virginia to just one in Wyoming and Georgia.
In addition, over half of the states are reporting most of the measures, with 17 reporting six measures and 14 reporting five measures. This shows that even though some states are reporting just a few measures, they can work toward reporting most or all the measures, as did their neighboring states.
Note: Montana and Massachusetts did not have an available 1115 SUD waiver file for review and may be reporting more measures than listed. A detailed breakdown of specific core OUD treatment measures reported by states through CMS programs can be found in the data download. The information reported is current as of the dates specified in the Excel file, which range from 2019 to 2023.
Most states are collecting and reporting data on the core OUD treatment measures through CMS programs. Doing so is a first step, but these data points must be paired with a plan to act on the data and make responsive policy changes. All states should strive to report on the full set of core OUD treatment measures and develop a strategy to integrate data they already collect into efforts to improve their OUD treatment systems, and ultimately save lives.
Methodology
This analysis draws on publicly available documents from the CMS federal fiscal year 2020 health homes and behavioral health core set chart packs and 1115 SUD waiver monitoring protocols from 2019 to 2023 to identify state trends. As outlined in the attached Excel file, after reviewing the sources, the research team determined whether a state reports a measure based on several criteria and included notes where appropriate. To verify findings, the research team sent review results to state behavioral health and Medicaid agencies from April to August 2023. The team also sent several reminders, and it received responses from most states, although four states did not respond (Alaska, Iowa, Tennessee, and Montana).
Vanessa Baaklini is a senior associate and Frances McGaffey is an associate manager with the substance use prevention and treatment initiative.
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