Alternative payment models and alcohol use disorder treatment and consequences

PROJECT SUMMARY
Alcohol Use Disorder (AUD) is one of the leading causes of preventable death in the US and has high personal
and societal costs. Despite the widespread acceptance that evidence-based treatments exist for AUD, less
than one in nine individuals with AUD report receiving specialty treatment. Challenges are particularly acute in
disadvantaged communities. Only 60 percent of US counties have a specialty substance use disorder (SUD)
treatment clinic that accepts Medicaid, despite Medicaid being the largest payer of addiction treatment services
in the US. In 2017, The Centers for Medicare and Medicaid Services initiated the Certified Community
Behavioral Health Clinic (CCBHC) demonstration, a program designed to increase access and the receipt of
evidence-based care in Medicaid in eight states. As a part of this initiative, CCBHCs were required to provide
nine services chosen to improve access; to provide data on quality metrics; and to engage in a prospective
payment system. Since the initial 66-clinic demonstration, the CCBHC program has expanded to over 240
clinics in 40 states; A primary distinction between the initial demonstration and the expanded model is that in
the expanded model clinics retain traditional reimbursement mechanisms but are awarded a large annual grant
(~$2 million). We use a quasi-experimental approach to compare changes in the receipt of AUD services
before and after CCBHC program implementation with changes in the receipt of AUD services in a set of
matched comparison clinics (or counties). Our project brings together an interdisciplinary team of health
services researchers, physicians, and economists with the methodological and substantive expertise to
examine this understudied issue and explore its complex public health, clinical, and policy implications. Our
specific aims are to assess whether CCBHC implementation was associated with: 1a) Changes in AUD
identification and treatment quality; 1b) Differential changes in AUD identification and treatment quality in
demonstration versus expansion clinics; 2) Differential changes in AUD treatment receipt and quality during the
COVID-19 public health emergency in CCBHC compared to non-CCBHC clinics; and 3) Changes in
trajectories of public health outcomes, including county-level reports of crime and alcohol-involved fatal motor
vehicle accidents. This grant is responsive to NOT-AA-20-022, “Notice of Special Interest: Advances in
Research for the Treatment, Services, and Recovery of Alcohol Use Disorder” and will provide
information ‘to bridge the gap between those who need treatment and those who receive treatment.’ In
addition, we focus on the Medicaid program, which disproportionately serves NIH-designated US health
disparity populations. The significance of this study lies in its focus on how to optimize delivery systems to
improve treatment and outcomes associated with AUD, a growing challenge and understudied policy issue.

Grant Number: 5R01AA030170-04
NIH Institute/Center: NIH
Principal Investigator: Susan Busch