Most Medicare patients with opioid use disorder do not receive recommended treatment.
A recent study in Health Affairs examined how well Medicare patients with opioid use disorder receive recommended treatment and found that the results are troubling. Researchers looked at Medicare enrollment, claims, and encounter data for 2020, focusing on whether beneficiaries with opioid use disorder were receiving care that met eight nationally recognized standards, and the data clearly showed Medicare falls short. In fact, less than 40 percent of these patients received treatment that met these quality measures. When comparing different types of Medicare coverage, Medicare Advantage performed worse than traditional fee-for-service Medicare in six out of eight measures. The study also found that Medicaid generally provided higher-quality care than Medicare for the few measures that could be compared.
The study’s findings demonstrate how Medicare falls short in treating patients with opioid use disorder. Across nearly all measures, fewer than 30 percent of patients received treatment that met the recommended standards, and even the highest-performing measures did not exceed 40 percent. These results suggest that Medicare beneficiaries are much less likely to receive high-quality opioid treatment than Medicaid beneficiaries, marking an important finding in research on care for this population. Previously, studies on Medicare focused mostly on the number of beneficiaries receiving medication for opioid use disorder, leaving other quality measures largely unexplored.
Several strategies could help improve treatment for Medicare patients. Expanding Medicare coverage and encouraging more providers to treat patients with opioid use disorder could increase access to care. Programs that improve follow-up care after hospitalizations or emergency visits may help patients stay engaged in treatment. Efforts to make patients aware of treatment options and the benefits of care could also increase participation. Many people with opioid use disorder do not seek treatment because they do not believe it will help, so outreach and education may be a key part of improving outcomes.
Prior authorization requirements for opioid treatment have been identified as a major barrier. Providers report that the extra paperwork and approval processes discourage them from treating Medicare patients. Removing or simplifying these requirements has been shown to increase access to medications like buprenorphine and methadone. Another approach to improving access is to increase the number of providers who can prescribe these medications. In 2022, about one-third of U.S. counties had no providers treating Medicare patients with these medications. Changes in federal policy, such as removing the X-waiver requirement for prescribing buprenorphine, have led to a rapid increase in the number of prescribers, demonstrating that policy adjustments can make a real difference.
Emergency department programs are also showing promise. Patients diagnosed with opioid use disorder in the emergency department can be started on medication immediately and connected with ongoing treatment after discharge. These programs, often called bridge programs, help maintain continuity of care and increase the likelihood that patients will stay in treatment.
Overall, the study shows that Medicare falls short in helping patients being with opioid use disorder. It makes clear that these patients are not receiving treatment that meets national standards. Monitoring quality measures regularly could help Medicare identify gaps in care and inform policies to improve access and outcomes. By reducing barriers, expanding provider availability, and supporting follow-up care, Medicare could help more patients get the treatment they need to recover from opioid use disorder.
Sources:
The Quality Of Opioid Use Disorder Treatment In Medicare Is Low And Lags Behind Medicaid
HHS awards $1.5 billion in opioid response grants to states, tribal communities
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