Predictors of Medicaid managed care plan performance on opioid use disorder treatment quality metrics

Medicaid managed care plans (MCPs) and states play essential roles in supporting access to high-quality opioid use disorder (OUD) treatment services. This study aimed to identify MCP and state-level policies associated with better plan performance on indicators of quality OUD treatment.

Publicly available data on Medicaid MCPs' profit status, behavioral health contracting arrangements, market share, buprenorphine prior authorization and quantity limit policies and state Medicaid policies were linked with plan-level measures of OUD treatment quality from the National Committee on Quality Assurance (n = 107). Regression analyses were used to examine associations between Medicaid MCP characteristics, MCP buprenorphine policies, and features of the state policy environment with plan-level rates of OUD treatment initiation and engagement.

The average OUD treatment initiation rate was 59.6 % and engagement was 30.9 %. MCPs with large market share had initiation and engagement rates 4.66 and 4.54 percentage points lower, respectively, than plans with small market share. Plans operating in states with 1115 SUD waivers had initiation and engagement rates 7.75 and 8.55 percentage points higher, respectively, than plans in states without waivers. Engagement rates among plans that required prior authorization for buprenorphine were 4.53 percentage points lower than plans without this restriction.

Findings suggest state and MCP policies are important pathways to improve initial and sustained OUD treatment. Further research into these relationships is needed.