How are Substance Use Disorder Treatment Programs Adjusting to Value-Based Payment? A Statewide Qualitative Study

O’Grady, Megan A.; Lincourt, Patricia; Gilmer, Evan; Kwan, Michael; Burke, Constance; Lisio, Carla; Neighbors, Charles J.

doi:10.1177/1178221820924026

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Thus, the change to value-based payments could be perceived as adding regulatory and financial risks for both public and private sectors. Similar to challenges identified in our study, in a study of value-based care for substance use disorder treatment, researchers identified providers’ buy-in to value-based concepts as a key workforce challenge [ 11 ]. Additionally, we found developing a template for value-based contracts was perceived as a lower priority compared to other organizational and state initiatives due to limited agency bandwidth and competing priorities during the COVID-19 global pandemic.…”

Section: Discussionmentioning

confidence: 70%

Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study

Zhao,

Varisco,

Borghouts

et al. 2024

BMC Health Serv Res

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Background Inadequate and inequitable access to quality behavioral health services and high costs within the mental health systems are long-standing problems. System-level (e.g., fee-for-service payment model, lack of a universal payor) and individual factors (e.g., lack of knowledge of existing resources) contribute to difficulties in accessing resources and services. Patients are underserved in County behavioral health systems in the United States. Orange County’s (California) Behavioral Health System Transformation project sought to improve access by addressing two parts of their system: developing a template for value-based contracts that promote payor-agnostic care (Part 1); developing a digital platform to support resource navigation (Part 2). Our aim was to evaluate facilitators of and barriers to each of these system changes. Methods We collected interview data from County or health care agency leaders, contracted partners, and community stakeholders. Themes were informed by the Consolidated Framework for Implementation Research. Results Five themes were identified related to behavioral health system transformation, including 1) aligning goals and values, 2) addressing fit, 3) fostering engagement and partnership, 4) being aware of implementation contexts, and 5) promoting communication. A lack of fit into incentive structures and changing state guidelines and priorities were barriers to contract development. Involving diverse communities to inform design and content facilitated the process of developing digital tools. Conclusions The study highlights the multifaceted factors that help facilitate or hinder behavioral health system transformation, such as the need for addressing systematic and process behaviors, leveraging the knowledge of leadership and community stakeholders, fostering collaboration, and adapting to implementation contexts.

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Section: Discussionmentioning

confidence: 70%

Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study

Zhao,

Varisco,

Borghouts

et al. 2024

BMC Health Serv Res

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“… 13 Further, this demonstration of value should include input from patients who are informed and selective about their healthcare options. 14 The systematic uptake of MBC and the assessment of performance via quality measures can help clinicians meet these expectations. In addition, a quality improvement program that includes systematic uptake of MBC can help ensure patients receive the same level of high-quality, evidence-based care regardless of the treatment setting.…”

Section: Background/rationalementioning

confidence: 99%

Addiction Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures

Clarke

Ibrahim

Doty

et al. 2021

SAR

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Introduction The need for innovative approaches to address the opioid epidemic in the United States is widely recognized. Many challenges exist to addressing this epidemic, including the obstacles outpatient substance use treatment practices face in implementing measurement-based care (MBC), quality measurement systems, and evidence-based treatments. Also, there are insufficient opportunities for clinicians in these settings to participate in research, resulting in diminished translation of research findings into community-based practice. To address these challenges, the Addiction Medicine Practice-Based Research Network (AMNet) was developed to facilitate the uptake of MBC in outpatient practices via implementation of patient-reported assessments and quality of care performance measures to improve patient outcomes. This network will offer clinicians in outpatient settings (not incuding opioid treatment programs [OTPs]) the opportunity to participate in future substance use disorder treatment research studies. Methods A key step in the development of AMNet was the selection of substance use-specific assessment tools and quality of care performance measures for incorporation into the American Psychiatric Association’s mental health patient registry, PsychPRO. A scoping review and multi-step consensus-based process were used to identify, review and select candidate assessment tools and quality of care performance measures for opioid use disorders (OUD) and substance use disorders (SUD). Results Following a consensus-based methodology, 12 standardized assessment tools and 3 quality of care performance measures for OUD and SUD were selected to help facilitate the implementation of MBC and quality improvement for AMNet participants. These tools were further categorized as core and optional. Conclusion By offering a collection of carefully vetted assessment tools and quality measures through PsychPRO, AMNet will help participating clinicians with the systematic uptake of MBC and delivery of evidence-based treatment for patients with SUD. Also, AMNet will act as a centralized repository of data collected from patients and clinicians in non-OTP outpatient addiction medicine practices and serve as a platform for opioid treatment research.

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“…Multiple systemic reviews have concluded that addiction treatment in the United States has large gaps in quality of care and limited capacity for clinical program improvement, and there are no agreed upon quality metrics for the SUD treatment field [67][68][69][70][71][72]. Notably, the workforce has limited levels of education or professional training to implement process change initiatives to improve clinical outcomes [67,70,71,73]. Because of this limitation, the proposed intervention will draw from our current research [74] based on principles of process improvement and the iPARIHS framework to coach OTPs on changing protocols and workflows to adopt more flexible THD [75][76][77][78][79][80][81][82].…”

Section: Introductionmentioning

confidence: 99%

Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes

Choi¹,

O’Grady²,

Cleland³

et al. 2023

PLoS ONE

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Introduction Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. Methods and analysis We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases—Medicaid, treatment registry, THD reporting—with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. Discussion This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE—particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.

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How are Substance Use Disorder Treatment Programs Adjusting to Value-Based Payment? A Statewide Qualitative Study

Cited by 7 publications

References 19 publications

Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study

Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study

Addiction Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures

Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes

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