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:
Table 1
| 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. |
Most states reported on at least one core OUD treatment measure, specifically:
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.
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.
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.
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.