Principal Investigator: April D. Kimmel, Ph.D.

Funding Source: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS)

Project Summary: This project will leverage administrative claims data to identify people living with HIV who are receiving medical care but not antiretroviral therapy, and will deliver both provider- and patient-level interventions that support prescription of, and adherence to, antiretroviral therapy. This work will develop and evaluate the clinical and cost effectiveness of a real-time intervention that can be scaled and implemented in other jurisdictions. Increasing the appropriate prescription of antiretroviral therapy and supporting medication adherence are critical for improving the health of people living with HIV, ultimately extending life expectancy and preventing onward HIV transmission.

Site Principal Investigator: Andrew J. Barnes, Ph.D.

Funding Source: University of Pittsburgh/National Institute on Drug Abuse (NIDA)

Project Summary: State Medicaid programs play a critical role in financing pharmacologic and non-pharmacologic treatments for opioid use disorder (OUD) as they provide coverage for 4 in 10 individuals with OUD. Efforts to improve access to high-quality OUD treatment in Medicaid have been hampered by inconsistent and incomplete measurement of quality and outcomes. States are currently taking myriad approaches to addressing the opioid crisis by changing the way they regulate providers, pay for care, and cover evidence-based treatments in Medicaid. However, there exists no analytic infrastructure for learning about the impact of state policy experimentation on OUD treatment and outcomes as states have no mechanism for sharing data or measurement tools. To overcome these challenges, we harness a Medicaid Distributed Research Network based on academic-state partnerships in Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia and Wisconsin. These states account for 15 million (20% of) Medicaid enrollees, and the partnerships have access to complete and recent Medicaid data.

The objectives of this application are to provide a comprehensive assessment of OUD treatment quality and outcomes in Medicaid, and to inform policy decisions on coverage and payment for evidence-based OUD treatments in Medicaid. First, we will construct and report on 15 standardized measures of OUD treatment performance in the nine states. Second, we will link Medicaid claims to vital statistics to examine the association between the quality of OUD treatment (e.g., adequate initiation, continuity, follow-up, monitoring, receipt of psychosocial care, screening) and fatal and non-fatal drug overdoses. Third, using quasi-experimental study designs, we will examine associations between Medicaid coverage policies, OUD treatment quality and overdose outcomes.

We focus on policy changes implemented recently to expand Medicaid coverage of and reduce barriers to pharmacologic treatment for OUD and to expand payment for residential treatment. Our network is uniquely positioned to disseminate our findings to state policy makers who can act on them. Our network is scalable. We will employ a robust dissemination strategy to distribute the analytic tools we develop to other states. Finally, our network is portable and can be harnessed to address not only the opioid crisis but future drug epidemics facing the US.

Principal Investigator: Peter J. Cunningham, Ph.D.

Funding Source: Virginia Department of Medical Assistance Services (DMAS)

Project Summary: The goal of the Addiction Recovery Treatment Service (ARTS) evaluation is to quantitatively and qualitatively assess the impacts of the new ARTS program.

Post-ARTS substance use disorders: The major goal of claims data analysis is to assess changes in SUD treatment access, utilization and costs at six months after implementation of the ARTS benefit.

Principal Investigator: Peter J. Cunningham, Ph.D.

Funding source: Virginia Department of Medical Assistance Services (DMAS)

Project Summary: The goal of the CCC+ evaluation is to quantitatively and qualitatively assess the impacts of CCC+ on Medicaid members on quality of care and support services, patient satisfaction, and the overall costs of services to Virginia’s Medicaid program.

The ultimate goal is to rebalance the care provided in the community relative to nursing homes, thereby reducing the number of Medicaid members with complex care needs who reside or are admitted to nursing homes.

Principal Investigator: Peter J. Cunningham, Ph.D.

Funding source: Virginia Department of Medical Assistance Services (DMAS)

Project Summary: The goal of the Evaluation of the Medicaid Expansion is to provide technical assistance to DMAS in developing online dashboards to monitor Medicaid expansion, analyze hospital uncompensated care costs and analyze the impact of Medicaid expansion on enrollment, utilization and health outcomes of Medicaid members.

Additionally, the program will assess the readiness of the primary care and behavioral health system to manage the increased demand for care expected through Medicaid expansion. VCU will develop metrics to track the local primary care and behavioral health systems’ capacity to expand service to meet new demand from the expansion and will conduct analysis to inform potential policy actions that could increase the capacity of primary care and behavioral health systems for Medicaid members.

Multiple Principal Investigator: Andrew Barnes, Ph.D.

Funding source: National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative, University of Pittsburgh, AcademyHealth's Evidence-Informed State Health Policy Institute

Project Summary: State Medicaid agencies play a critical role in covering OUD treatment, as more than half (54 percent) of individuals who need OUD treatment use Medicaid to pay for these expenses. Additionally, Medicaid programs disproportionately cover minoritized populations and those with socioeconomic risk factors, allowing Medicaid to reduce inequities in care. Despite past efforts of expanding the continuum of care and improving the quality of OUD care, underdeveloped OUD quality measures remain a persistent issue.  

This limitation hinders opportunities for targeted intervention and thorough evaluation of policy effects, creating a need for research and policy partnerships. MODRN EQUIP will draw on robust university-state partnerships in 12 states accounting for 24 percent of U.S. Medicaid enrollment to support efforts to improve OUD quality.  

Throughout the five years of funding, MODRN EQUIP, led by Multi-Principal Investigators Julie Donohue, Ph.D. and Andrew Barnes, Ph.D. aims to: 

1. Develop and describe provider OUD treatment quality measures that are responsive to Medicaid program and stakeholder needs. Project 1 analyzes Medicaid claims and enrollment data and engages Delaware, Kentucky, Maryland, Maine, Michigan, North Carolina, Ohio, Pennsylvania, Tennessee, Virginia, West Virginia, and Wisconsin and is led by Project Directors Marguerite Burns, Ph.D. and Evan Cole, Ph.D., M.P.H. 
2. Test case-mix approaches to enable fair comparisons across providers in OUD treatment quality measures. Project 2 utilizes Medicaid patient surveys and interviews linked with Medicaid claims and engages Michigan and Virginia, led by Project Directors Andrew Barnes, Ph.D. and Sarah Clarke, M.P.H. 
3. Quantify the contribution of patient – and provider – factors, including between and within provider effects, on provider-level OUD treatment quality and equity. Project 3 examines Electronic Health Record (EHR) data from 10 intervention clinics; Medicaid claims from intervention and comparison clinics and engages Ohio. Project 3 is led by Project Directors Dushka Crane, P.h.D., L.S.S.B.B. and Adam J. Gordon, M.D., M.P.H., F.A.C.P., D.F.A.S.A.M.

Site Principal Investigator: Andrew Barnes, Ph.D.
Sire Co-Investigators: Peter Cunningham, Ph.D., Anika L. Hines, Ph.D.. M.P.H.

Funding Source: Patient-Centered Outcomes Research Institute (PCORI), AcademyHealth's Evidence-Informed State Health Policy Institute, University of Pittsburgh

Project Summary: Continued and increasing racial inequities in severe maternal morbidity and mortality constitute a public health crisis in the U.S., whose rates of maternal mortality far exceed those of comparable high-resource counties. Indeed, Black people in the U.S. experience pregnancy-related mortality rates approximately 3 times higher than white people – 55.3 and 19.1 per 100,000, respectively. Rates of severe maternal morbidity (SMM), which encompasses life-threatening conditions during pregnancy and postpartum, have increased by nearly 200% in the past 20 years and further reveal significant racial inequities. Because state Medicaid programs comprise the largest single source of healthcare coverage in the U.S., including covering 68% of pregnancy care among Black people, these programs hold great potential to implement structural interventions to advance racial equity in healthcare and health outcomes during pregnancy and postpartum, such as doula care services.

With support from the Patient-Centered Outcomes Research Institute (PCORI), AcademyHealth’s Evidence-Informed State Health Policy Institute and the University of Pittsburgh are conducting a study to identify the most effective ways that state Medicaid programs can implement doula care to improve postpartum health among Black people and people of color. The research will be conducted by university research teams from the Medicaid Outcomes Distributed Research Network (MODRN), who operate in six states in various stages of implementing Medicaid doula care programs: Kentucky, Maryland, Michigan, Pennsylvania, South Carolina, and Virginia. This community-engaged research will include partnerships with 9 doula organizations, as well as engaging with Medicaid patients and state Medicaid agency officials.

This first-of-its-kind study will draw on the research infrastructure and existing partnerships of MODRN, as well as perspectives and lived experiences from doulas and Medicaid patients, to provide much-needed evidence on how doula programs can promote positive birth outcomes and reduce racial disparities in SMM.