Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont

Abstract

In the face of increasing rates of overdose deaths, escalating health care costs, and the tremendous social costs of opioid addiction, policy makers are asked to address the questions of whether and how to expand access to treatment services. In response to an upward trend in opioid abuse and adverse outcomes, Vermont is investing in statewide expansion of a medication-assisted therapy program delivered in a network of community practices and specialized treatment centers (Hub & Spoke Program). This study was conducted to test the rationale for these investments and to establish a pre-Hub & Spoke baseline for evaluating the additive impact of the program. Using a serial cross-sectional design from 2008 to 2013 to evaluate medical claims for Vermont Medicaid beneficiaries with opioid dependence or addiction (6158 in the intervention group, 2494 in the control group), this study assesses the treatment and medical service expenditures for those receiving medication-assisted treatment compared to those receiving substance abuse treatment without medication. Results suggest that medication-assisted therapy is associated with reduced general health care expenditures and utilization, such as inpatient hospital admissions and outpatient emergency department visits, for Medicaid beneficiaries with opioid addiction. For state Medicaid leaders facing similar decisions on approaches to opioid addiction, these results provide early support for expanding medication-assisted treatment services rather than relying only on psychosocial, abstinence, or detoxification interventions.

Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome Among Rural US Residents, 2007–2014

“…Both the policy dialogue and the programmatic responses to OUD during pregnancy ought to account for rural residents who may be referred or transferred to urban settings, while also strengthening the resources in rural communities to ensure successful management of the growing number of opioid‐affected pregnancies. Promising strategies include formal collaborations between urban‐based systems and smaller rural clinics and hospitals, such as Project ECHO and Vermont's Hub and Spoke model . Both of these care models ought to be rigorously assessed for potential expansion in other rural US locations where resources to care for opioid‐affected births may be limited.…”

“…Promising strategies include formal collaborations between urban-based systems and smaller rural clinics and hospitals, such as Project ECHO and Vermont's Hub and Spoke model. [41][42][43][44][45] Both of these care models ought to be rigorously assessed for potential expansion in other rural US locations where resources to care for opioid-affected births may be limited.…”

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact

“…Before expansion of OAT in Vermont in 2012, individuals with at least 2 claims for OUD or opioid dependence in a calendar year had healthcare costs derived from Medicaid Claims Data that were higher than those without claims (Mohlman et al, 2016). Since 2013, these overall healthcare costs, including the cost of OAT, have dropped by 7% to 10% (Krantz, 2014).…”

Reductions in emergency department presentations associated with opioid agonist treatment vary by geographic location: A retrospective study in New South Wales, Australia

“…These findings contribute to the growing body of evidence documenting reductions in health service use and associated costs among people with OUD while prescribed OAT. Such studies have largely been undertaken in the USA, using state‐based Medicaid data or insurance claims databases . Our study suggests these benefits are obtained in a setting with universal health care, while identifying that benefits may not translate to geographical areas with limited access to OAT.…”