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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
  • 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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