Performance measurement for medication assisted treatment with buprenorphine
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Performance Measurement for Medication-Assisted Treatment with Buprenorphine: . Translating Evidence-Based Practices Such as Medication-Assisted Treatment into Public Purchasers’ Performance Measures Suzanne Gelber, MSW, Ph.D.

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Performance measurement for medication assisted treatment with buprenorphine

Performance Measurement for Medication-Assisted Treatment with Buprenorphine:

Translating Evidence-Based Practices Such as Medication-Assisted Treatment into Public Purchasers’ Performance Measures

Suzanne Gelber, MSW, Ph.D.

March 20-21 Summit on Performance Measurement for California’s Division of Alcohol and Drug Programs


Performance measurement incorporating evidence based medication assisted buprenorphine treatment
Performance Measurement Incorporating Evidence-Based Medication-Assisted Buprenorphine Treatment

  • States and counties are increasingly required to make maximum use of nationally accepted evidence-based practices, widely accepted performance and accreditation measures and outcomes reports in MAT as in other types of treatments

  • Payer-specific fiscal and clinical performance-based accountability reports have proliferated and include the GPRA measures, NOMS/CalOMS and other reporting/performance required by the Legislature and/or the courts/criminal justice system

  • To support the wider dissemination of EBP’s in SUD treatment, as well as to provide consensus measures, the National Quality Forum (NQF) issued a landmark report on “Evidence-Based Treatment Practices for Substance Use Disorders” (NQF 2005), including opiod therapies as examples of Evidence-Based Practices

  • CSAT’s Washington Circle Group, cooperating with the NQF, is developing and pilot testing performance measures for Medication Assisted Treatment (www.washingtoncircle.org/medtreatment)


Performance measurement for buprenorphine treatment a public purchaser s challenge
Performance Measurement for Buprenorphine Treatment: A Public Purchaser’s Challenge

  • NQF EB Practices reports (2004-05) highly recommend adopting therapeutic addiction-focused pharmacotherapy and counseling for all patients (adolescents and adults) with alcohol and/or opiod dependence

  • Performance measurement in EBP MAT is complicated by historical public sector benefit designs and funding that did not envision MAT and/or MAT in MD offices, programs, pharmacy benefits, counseling, recovery support, continuing care

  • Requires long-term monitoring of combined or separate funding streams and providers for each person receiving MAT


Performance measurement for buprenorphine treatment a public purchaser s challenge1
Performance Measurement for Buprenorphine Treatment: A Public Purchaser’s Challenge

  • Pelletier’s 2004 report to NQF includes these EBP’s related to buprenorphine/methadone:

    • Buprenorphine/methadone/other appropriate detoxification and treatment, use of VHA/DOD/CSAT SUD practice guidelines, methadone maintenance therapy at differing dosages, and

    • EBP’s in accompanying psychosocial treatment for these patients: treatment matching, community-oriented recovery support programs, continuing care to prevent acute episodes, promote long-term retention in treatment/recovery

  • Buprenorphine performance measurement requires tracking and integrating several different funding streams and different providers over time for detoxification, medication and therapy/recovery support and continuing care (treatment) for the same treatment recipient

  • Changing eligibility for different funding streams/benefits makes such tracking difficult; requires unique patient ID’s maintained over time


Purchasers concerns can become internal performance measures
Purchasers’ Concerns Can Become Internal Performance Measures

  • Primary MAT concerns voiced by public purchasers and policymakers : cost of MAT (especially in fixed pie situations); clinical safety/overdose potential; diversion/public safety potential of medications; needs for documented savings in 12-36 month timeframes to offset public sector investments in MAT – can become “internal” performance measures

  • Immediate internal concerns need to be added to current external PM’s and outcomes reports for WC or NOMS/SOMS/other paradigms

  • After a slow start in the public sector, buprenorphine now has more public sector momentum (NY, PA, VT, FLA, WA, other states in process), using Medicaid and other funding streams

  • MAT for alcoholism will require similar system attention

  • Internal and external performance measurement and EBP’s for SUD must and can now accompany wider initiation of accountable buprenorphine/other MAT treatments in the public sector


Washington circle medication assisted treatment measure process
Washington Circle Medication-Assisted Treatment Measure Process

  • WC measures that purchasers can use for MAT performance are in progress (MAT Workgroup)

  • WC measures are built on the stages of the treatment process itself and the chronic disease model, including:

    • Identification

    • Initiation

    • Engagement in treatment

    • Retention/Continuing Care

    • Recovery Support Services


Washington circle medication assisted treatment measure process for buprenorphine and alcohol
Washington Circle Medication-Assisted Treatment Measure Process for Buprenorphine and Alcohol

  • WC measures for MAT include these features:

    • Measures of processes of care for adults

    • Combined measure for opiod and alcohol dependence with separate reports for each

    • Excludes methadone (developed elsewhere)

    • Initiation and duration of treatment measures

    • Utility for primary and specialty treatment settings

    • Counseling considered where data permits

    • Measured prescribing

    • EHR and database friendly


Next steps
Next Steps Process for Buprenorphine and Alcohol

  • Assess immediate and longer term performance measurement needs and applicability to buprenorphine and other MAT’s for alcohol, opiods

  • Actively review work of WC MAT workgroup and NQF

  • Decide which performance measures to use for immediate and longer term purposes to satisfy accountability AND continuous improvement challenges, including establishing benchmarks

  • Special role for CA: one of the biggest and most influential markets that other states imitate; t is not too late for CA to once again set the standard nationally in PM for MAT’s

  • Late initiation of public sector buprenorphine treatment in CA provides opportunity to pilot performance measurement process that works for all stakeholders


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