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Vermont Medicaid (ACS-19)

IET: Initiation of Alcohol & Other Drug Dependence Treatment - Age 18 & Older* (ACS-19)

Current Value

47.1%

2019

Definition

Line Bar

Notes on Methodology

  • The annual reported rate captures activity during the previous calendar year.
  • This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
    • Beneficiaries with Medicare or other medical insurance were not included.
    • In Vermont Medicaid, medication assisted treatment (MAT) is currently billed as one unit per month. The HEDIS IET specification looks for one service within 14 days of index event to count as initiation and two services within 34 days of initiation for engagement. The DVHA Data Unit adjusted the IET rate to account for the multiple visits each week occurring at the MAT opioid treatment programs.
    • VT billing codes for behavioral health residential treatment do not match the IET measure, but for this measure are counted as sub-acute facility visits
  • Based on the advice of their External Quality Review Organization (EQRO), DVHA's rates only include Medicaid Primary beneficiaries in HEDIS administrative measures as of 2014.
  • The red dashed trend line above is the 50th percentile national benchmark for Medicaid programs. DVHA will align with the All Payer Model (APM) benchmarks (currently under development) of the 50th percentile of health care plans nationally - the average of all payers when they become available.
  • Due to significant changes that were made to the IET measure technical specifications for the HEDIS 2018 season, 2018 has been set as the new baseline measurement year for this measure. Historic data remains on the trend line above, but comparisons to baseline will not begin until after the HEDIS 2019 season's rates are available. Changes to the technical specifications include guidelines for incorporating telehealth and MAT services, as well as specifications for reporting out by substance type (alcohol, opioids and other substances).

 

Story Behind the Curve

This measure assesses the degree to which Vermont Medicaid initiates (starts) and engages (continues) treatment for members identified with a need for alcohol and other drug dependence (AOD) services.

Two rates are reported for this measure:

  1. Initiation – the % of Medicaid beneficiaries 13 years of age & older diagnosed with AOD dependence who start treatment through an inpatient AOD admission or an outpatient service for AOD abuse or dependence within 14 days.
  2. Engagement – the % of Medicaid beneficiaries 13 years of age & older diagnosed with AOD dependence who then received two (2) additional AOD services within 34 days after the start of AOD treatment.

The Adult Core Set asks states to report the rate for the subset of members 18 years of age & older (shown above).

The need for Vermont to work on our increasing opioid use epidemic is well documented and has garnered media and public attention over the past few years. Possibly less well known, is the fact that alcohol abuse, on its own, still represents the larger percentage of substance abuse for Vermonters. Please read further under “What Works” and “Action Plan” to learn more about what Vermont Medicaid is doing to help Vermonters prevent and treat substance abuse.

Last updated:  February 2020

Partners

  • Vermont Medicaid beneficiaries and families
  • Community Providers – such as Licensed Alcohol & Drug Counselors (LADCs), primary care physicians and mental health practitioners
  • Hospitals
  • Blueprint for Health
  • OneCare Vermont
  • Other Agency of Human Services Departments
    • Vermont Department of Health’s Alcohol and Drug Abuse Programs (ADAP)
    • Department of Children and Families
    • Department of Mental Health
    • Department of Corrections

What Works

This link to the Vermont Department of Health website contains information about substance use treatment centers in Vermont, the Care Alliance for Opioid Addiction, medication assisted therapy (MAT), as well as other parent and community resources:  http://www.healthvermont.gov/a...

Action Plan

This measure and this topic, Initiation of Alcohol and Other Drug Dependence Treatment, has been a high priority for Vermont Medicaid for years. Between 2013-2015 we worked on a grant funded Quality Improvement Project with the goal of increasing our substance use disorder treatment rates. We focused on opening up the Medicaid provider network to Licensed Alcohol and Drug Counselors (LADCs). We also offered a payment reform approach, by providing enhanced payment for quality outcomes. As you can see from the line graph above, these strategies did not significantly increase the overall treatment rates for Medicaid beneficiaries.

Although this is clearly a multi-faceted and difficult issue to impact, we have chosen substance use treatment as a topic for a more formal Performance Improvement Project (PIP), results of which were submitted to CMS starting in 2017. Department of Vermont Health Access (DVHA) Quality Unit staff have partnered with staff in the Health Department's Alcohol and Drug Abuse Programs (ADAP), the Blueprint for Health and OneCare Vermont to design a project meant to drive more Vermonters newly diagnosed with a substance use disorder to treatment. Activities we have engaged in thus far include:

  • attending Blueprint for Health/OneCare All Field Team meetings to present data and evidence-based interventions to community-level quality improvement leads. Community-level gap analyses have been recommended,
  • proposing a method to improve the accuracy and completeness of the claims-based data from which the IET measure is derived,
  • assessing access to treatment appointments. The team administered a telephone survey to a state-wide sample of substance use treatment providers related to their appointment availability. The results of the survey are being analyzed and will determine a new intervention strategy.

Clear Impact Suite is an easy-to-use, web-based software platform that helps your staff collaborate with external stakeholders and community partners by utilizing the combination of data collection, performance reporting, and program planning.

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