Transcript Slide 1

Performance Measurement
for Medication-Assisted
Treatment with
Buprenorphine:
Translating Evidence-Based Practices Such as MedicationAssisted 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
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Performance Measurement Incorporating
Evidence-Based Medication-Assisted
Buprenorphine Treatment
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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)
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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
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Performance Measurement for
Buprenorphine Treatment: A Public
Purchaser’s Challenge
 Pelletier’s 2004 report to NQF includes these EBP’s related to
buprenorphine/methadone:
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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
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Purchasers’ Concerns Can
Become Internal Performance
Measures
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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
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Washington Circle MedicationAssisted 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:
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Identification
Initiation
Engagement in treatment
Retention/Continuing Care
Recovery Support Services
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Washington Circle MedicationAssisted 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
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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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