(52) Addiction Treatment Program Quality Measures: Results of a NIDA-Funded Study

Background & Introduction: Evidence from over 140 controlled trials demonstrated that peer-comparative performance feedback is an effective strategy for improving health care providers’ processes and outcomes (Jamtvedt et al., 2006). The Centers for Medicare & Medicaid Services (CMS) disseminates hundreds of quality measures across various provider types and programs, including hospitals, nursing homes, Skilled Nursing Facilities (SNF), hospice, home health, dialysis, and physicians. However, there are no standardized, casemix adjusted metrics to help drive improvement among addiction treatment programs.

In 2023, NIDA funded research to fill this gap by testing and developing addiction treatment quality measures and quality improvement approaches. (NIDA, 2026) This presentation describes the results of the development and testing of three casemix adjusted opioid treatment program (OTP)-level quality measures and benchmarks: (1) OTP retention for at least 30-days, 90-days, or 180-days after initiation at the OTP; (2) Transition on a Medication for Opioid Use Disorder (MOUD) within 30 days after discontinuing at the OTP; (3) Continuation on a MOUD

Methods: The measures were selected and developed after reviewing the evidence on factors that influence positive outcomes from OUD and OTP treatment and with input from advisory panels of OTP clinicians and OTP patients. Retention on MOUD was selected as a focus because it is associated with lower risk of overdose and death. (Ma et al., 2019; Sordo et al., 2017)

We utilized claims and enrollment data for Medicaid enrollees from CMS for United States, covering the period from June 1, 2017, to December 31, 2023. Medicaid data was used becuase it is available and because Medicaid beneficiaries comprise at least 60% of all admissions to OTPs and approximately half of all opioid overdose deaths (Mark and Huber, 2024).

The measures were created for Medicaid beneficiaries with a primary OUD diagnosis on an OTP outpatient Medicaid claim, aged 18 years or older, who were not dually enrolled in Medicare. Beneficiaries dually eligible for Medicare were excluded because Medicare is the primary payer and the source of prescription drug coverage. To identify OTPs, we utilized national provider identifier (NPI) numbers which are unique, 10-digit numbers assigned to healthcare providers. Measures were created for “measure years” (MY) 2018 through 2023.

Results: In MY2023, the measures were created for approximately 1,130 OTPs treating 260,000 patients for 430,000 episodes.

We used the performance of the 75th percentile OTP as the benchmark because it is attainable but also a “stretch goal.” We also reported on the
median and 25th percentile. The 25th and 75th percentile are summarized as the interquartile range (IQR).

The ”typical” (median) OTP demonstrated substantial room for improvement in the quality measures and there was wide variation in performance among OTPs.
Casemix adjustment resulted in some OTPs moving above the 75th benchmark, and others moving below it.
Higher performance by the OTP on the measures was associated with lower odds of SUD primary diagnosis hospitalizations or ED visits and SUD-related mortality.
The median and IQR of the measures were:
1) OTP retention. The median and IQR of the > 30-day, > 90-day, and > 180-day OTP retention rate measures were 61.2% (IQR: 40.9% - 73.5%), 41.5% (22.2%-54.8%), and 27.5% (11.4%-40.5%).
2) Transition on a MOUD within 30 days after Discontinued from OTP. The median and IQR of the transition measure was 37.8% (IQR: 25.8% - 53.4%)
3) Retention on MOUD for at least 180-days. The median 180-day MOUD retention rate measure was 34% in 2023 (IQR: 22% - 44%)

Conclusion & Discussion: OTP quality measures can be important tools for improving retention and outcomes. Quality measures created from claims data allow OTPs to understand their patients outcomes relative to national and state benchmarks. Claims data also allow OTPs to examine patient outcomes outside of the OTPs. This study describes three OTP-quality measures that are valid, highly variable, and useful for improving outcomes among patients receiving treatment OTPs. By understanding their quality, OTPs may be further motivated to undertake evidence-based quality improvement activities such as ensuring adequate dosing and reducing transportation and other barriers to MOUD receipt.

References: Jamtvedt, G., Young, J.M., Kristoffersen, D.T., O'Brien, M.A., Oxman, A.D., 2006. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst. Rev., CD000259.

Ma, J., Bao, Y.P., Wang, R.J., Su, M.F., Liu, M.X., Li, J.Q., Degenhardt, L., Farrell, M., Blow, F.C., Ilgen, M., Shi, J., Lu, L., 2019. Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis. Mol. Psychiatry. 24, 1868-1883.

Mark TL, Huber BD. Drug Overdose Deaths Among Medicaid Beneficiaries. JAMA Health Forum. 2024 Dec 6;5(12):e244365.

National Institute of Drug Abuse. HEAL Initiative: Research to Foster an Opioid Use Disorder Treatment System Patients Can Count On (RM1 - Clinical Trial Optional) https://grants.nih.gov/grants/guide/rfa-files/RFA-DA-23-046.html (accessed January 17, 2026)

Sordo, L., Barrio, G., Bravo, M.J., Indave, B.I., Degenhardt, L., Wiessing, L., Ferri, M., Pastor-Barriuso, R., 2017. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 357, j1550.