Treatment for opioid use disorder in the Florida Medicaid population: A cascade of care approach to assessing quality.

Kimberly Johnson, Ph.D.
University of South Florida

ABSTRACT:
Despite increased funding, opioid overdose rates remain high. Understanding at what stage of the process and for whom the system is failing is critical to improving care. A cascade of care (CoC) model may improve understanding of gaps in addiction treatment availability and quality over current single measure methods. Using a CoC framework, we assessed treatment quality and outcomes for opioid use disorder for the Florida Medicaid population in 2017/2018 by demographics.

Methods: Data from Florida Medicaid claims for 2017 and 2018 were used to calculate the number of enrollees who were diagnosed, began medication, were retained on medication for a minimum of 180 days, and who died.

Results: Only 28% of those newly diagnosed with OUD in 2017 began treatment with an FDA approved medication. Once on medication, 38% of newly diagnosed enrollees were retained in treatment for at least 180 days. Those who remained in treatment for 180 days had a hazard ratio of death of 0.226 (95% CI = 0.174 to 0.294) compared to those that did not initiate treatment, a reduction in mortality from 10% without care to 2% with care.

Conclusions: Initiating medication after diagnosis is the process most in need of improvement, though there is much room for improvement in treatment retention as well. The CoC is an appropriate method of measuring the quality of the functioning of the treatment system at the state level.