Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment

Crable, Erika L.; Benintendi, Allyn; Jones, David K.; Walley, Alexander Y.; Hicks, Jacqueline Milton; Drainoni, Mari-Lynn

doi:10.1186/s13012-021-01182-4

Cited by 38 publications

(42 citation statements)

References 42 publications

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“…Many other studies identify the use of PA as a barrier to timely receipt of MOUD and continuity of care. [12][13][14][15][16][17][18][19][20][21] Removal of PA in Medicare Part D plans, following an FDA labeling change for buprenorphine products and related Centers for Medicare & Medicaid Services (CMS) guidance, 22 was associated with an increase in prescribing of buprenorphine and naloxone and a decrease in substance use disorder-related inpatient admissions and emergency department visits. 16 Relatedly, removal of PA for MOUD was associated with a decrease in the likelihood of relapse among patients with OUD enrolled in a Medicare Advantage plan.…”

Section: Introductionmentioning

confidence: 99%

“…13 Prior authorization is also identified as a major barrier by buprenorphine prescribers serving Medicaid enrollees. 15,17 Although there is documentation of widespread use of PA for MOUD in Medicaid FFS programs in 2017, 9 little is known about MOUD coverage and PA policies in comprehensive Medicaid managed care organization (MCO) plans, which cover approximately 70% of all Medicaid beneficiaries. 23 A comparison of PA policies in Medicaid FFS programs and MCO plans in 3 states found variation in the use of PA for MOUD, 24 suggesting that additional research in this area is warranted.…”

Section: Introductionmentioning

confidence: 99%

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Coverage and Prior Authorization Policies for Medications for Opioid Use Disorder in Medicaid Managed Care

et al. 2022

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ImportanceMedicaid is a key policy lever to improve opioid use disorder treatment, covering approximately 40% of Americans with opioid use disorder. Although approximately 70% of Medicaid beneficiaries are enrolled in comprehensive managed care organization (MCO) plans, little is known about coverage and prior authorization (PA) policies for medications for opioid use disorder (MOUD) in these plans.ObjectiveTo compare coverage and PA policies for buprenorphine, methadone, and injectable naltrexone across Medicaid MCO plans and fee-for-service (FFS) programs and across states.Design, Setting, and ParticipantsThis cross-sectional study analyzed MOUD data from 266 Medicaid MCO plans and FFS programs in 38 states and the District of Columbia in 2018.Main Outcomes and MeasuresFor each medication, the percentages of MCO plans and FFS programs that covered the medication without PA, covered the medication with PA, and did not cover the medication were calculated, as were the percentages of MCO, FFS, and all (MCO and FFS) beneficiaries who were covered with no PA, covered with PA, and not covered. In addition, MCO plan coverage and PA policies were mapped by state. Analyses were conducted from January 1 through May 31, 2022.ResultsCoverage and PA policies were compared for MOUD in 266 MCO plans and 39 FFS programs, representing approximately 70 million Medicaid beneficiaries. Overall, FFS programs had more generous MOUD coverage than MCO plans. However, a higher percentage of FFS programs imposed PA for the 3 medications (47.0%) than did MCOs (35.9%). Furthermore, although most Medicaid beneficiaries were enrolled in a plan that covered MOUD, 53.2% of all MCO- and FFS-enrolled beneficiaries were subject to PA. Results also showed wide state variation in MCO plan coverage and PA policies for MOUD and the percentage of Medicaid beneficiaries subject to PA.Conclusions and RelevanceThis cross-sectional study found variation in MOUD coverage and PA policies across Medicaid MCO plans and FFS programs and across states. Thus, Medicaid beneficiaries’ access to MOUD may be heavily influenced by their state of residency and the Medicaid plan in which they are enrolled. Left unaddressed, PA policies are likely to remain a barrier to MOUD access in the nation’s Medicaid programs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Coverage and Prior Authorization Policies for Medications for Opioid Use Disorder in Medicaid Managed Care

et al. 2022

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“…Work mobilizing this approach highlights the analytical di culties associated with the wide range of health policy implementation practices in assessing its ability to achieve goals [11] [12]. To better understand these implementation practices, Crable et al [27] propose a taxonomy of local health policy implementation strategies in the USA based on the ERIC (Expert Recommendations for Implementing Change) project. This taxonomy makes it possible to describe in great detail the stakeholders involved in this implementation and their respective roles in it.…”

Section: The Issue Of Coordination Of Actorsmentioning

confidence: 99%

Local implementation of health public policies revealed by the Covid-19 crisis: the French case

Mériade

Rochette

Cassière

2022

Preprint

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Background Improving health system performance depends on the quality of health policy implementation at the local level. However, in general, the attention of researchers is mainly directed towards issues of health policy design and evaluation rather than implementation at the local level. The management of the Covid-19 crisis, especially in Europe, has particularly highlighted the complexity of implementing health policies, decided at the national or supranational level, at the local level. Methods We conducted 23 semi-structured interviews with the main stakeholders in the management of the Covid-19 crisis in the second largest French region in order to understand how this crisis has challenged the implementation of health policy and the arrangements found by the actors. Our methodology is complemented by a content analysis of the main guidelines and decisions related to this implementation. Results The analysis of these data allows us to identify three levels of implementation of health policies at the local level (administrative, organizational and operational). Interviews also reveal the existence of different types of coordination specific to each of these levels of local implementation of health policies. These results then make it possible to identify important managerial avenues for promoting global coordination of these three levels of implementation. Conclusions Although research on health services emphasizes the existence of several levels of local implementation of health policies, it offers little in the way of definition or characterization of these levels. The identification in this study of the three levels of local implementation of health policies and their specific forms of coordination contribute to a more precise characterization of this implementation in order to promote, in practice, its global coordination.

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“…D&I research frequently conceptualizes health policy as a distal environmental factor within a broadly defined outer context rather than as central to the research and as a target of D&I strategies [ 6 ]. Health policies can serve as implementation strategies that facilitate or mandate access to evidence-based health services [ 7 – 9 ]. Health policies can also represent the evidence-based law, rule, or “thing” [ 10 ] at the center of implementation efforts [ 5 , 11 – 14 ], act as determinants that enable or constrain D&I strategies from achieving desired outcomes [ 5 , 15 – 17 ], and potentially serve in other causal pathway roles (e.g., mechanisms).…”

Section: Introductionmentioning

confidence: 99%

Where is “policy” in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example

et al. 2022

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Background Implementation science aims to accelerate the public health impact of evidence-based interventions. However, implementation science has had too little focus on the role of health policy — and its inseparable politics, polity structures, and policymakers — in the implementation and sustainment of evidence-based healthcare. Policies can serve as determinants, implementation strategies, the evidence-based “thing” to be implemented, or another variable in the causal pathway to healthcare access, quality, and patient outcomes. Research describing the roles of policy in dissemination and implementation (D&I) efforts is needed to resolve persistent knowledge gaps about policymakers’ evidence use, how evidence-based policies are implemented and sustained, and methods to de-implement policies that are ineffective or cause harm. Few D&I theories, models, or frameworks (TMF) explicitly guide researchers in conceptualizing where, how, and when policy should be empirically investigated. We conducted and reflected on the results of a scoping review to identify gaps of existing Exploration, Preparation, Implementation, and Sustainment (EPIS) framework-guided policy D&I studies. We argue that rather than creating new TMF, researchers should optimize existing TMF to examine policy’s role in D&I. We describe six recommendations to help researchers optimize existing D&I TMF. Recommendations are applied to EPIS, as one example for advancing TMF for policy D&I. Recommendations (1) Specify dimensions of a policy’s function (policy goals, type, contexts, capital exchanged). (2) Specify dimensions of a policy’s form (origin, structure, dynamism, outcomes). (3) Identify and define the nonlinear phases of policy D&I across outer and inner contexts. (4) Describe the temporal roles that stakeholders play in policy D&I over time. (5) Consider policy-relevant outer and inner context adaptations. (6) Identify and describe bridging factors necessary for policy D&I success. Conclusion Researchers should use TMF to meaningfully conceptualize policy’s role in D&I efforts to accelerate the public health impact of evidence-based policies or practices and de-implement ineffective and harmful policies. Applying these six recommendations to existing D&I TMF advances existing theoretical knowledge, especially EPIS application, rather than introducing new models. Using these recommendations will sensitize researchers to help them investigate the multifaceted roles policy can play within a causal pathway leading to D&I success.

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Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment

Cited by 38 publications

References 42 publications

Coverage and Prior Authorization Policies for Medications for Opioid Use Disorder in Medicaid Managed Care

Coverage and Prior Authorization Policies for Medications for Opioid Use Disorder in Medicaid Managed Care

Local implementation of health public policies revealed by the Covid-19 crisis: the French case

Where is “policy” in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example

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