Quality of Buprenorphine Care for Insured Adults with Opioid Use Disorder

Kelly E. Anderson; Brendan Saloner; Julia Eckstein; Christine E. Chaisson; Sarah H. Scholle; Lauren Niles; Sydney Dy; G. Caleb Alexander

doi:10.1097/MLR.0000000000001530

Quality of Buprenorphine Care for Insured Adults with Opioid Use Disorder

Kelly E. Anderson, Brendan Saloner, Julia Eckstein, Christine E. Chaisson, Sarah H. Scholle, Lauren Niles, Sydney Dy, G. Caleb Alexander

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

Abstract

Aim: The aim of this study was to characterize quality of buprenorphine care for opioid use disorder (OUD) by quantifying buprenorphine initiation, engagement, and maintenance for individuals in a large, diverse, real-world cohort in the United States. Design: This was a retrospective cohort analysis. Setting: OUD treatment in the outpatient setting. Participants: A total of 45,210 commercially insured and Medicare Advantage (MA) enrollees 18 years or older in the OptumLabs Data Warehouse with an index diagnosis of OUD between January 1, 2018 and December 31, 2018. Interventions: Treatment with buprenorphine. Measurements: We calculated 6 measures of buprenorphine treatment quality. We conducted survival analyses to characterize treatment duration and logistic regressions to evaluate the association between clinical and sociodemographic characteristics and quality. Findings: Of 45,210 eligible individuals with OUD, ~1 in 10 (n=4600, 10.2%) initiated buprenorphine within 365 days following diagnosis (Measure #1) and 2850 individuals (6.3%) initiated buprenorphine within 14 days of diagnosis (Measure #2). Of individuals initiating treatment within 14 days of diagnosis, 1769 (62.1%) had 2 or more buprenorphine claims within 34 days of initiation (Measure #3). Of the 4600 individuals who received buprenorphine, 2300 (50.0%) were maintained in care with 180 days or more of covered buprenorphine treatment during 365 days after diagnosis (Measure #4). Finally, of the 4600 individuals who received buprenorphine, 2543 (55.3%) did not fill any other concurrent opioid analgesic (Measure #5) and 2951 (64.2%) did not fill any concurrent benzodiazepine (Measure #6). Quality was generally lower for individuals with MA compared with commercial coverage and among Hispanic and Black adults compared with White adults. Conclusion: Widespread gaps exist in quality of buprenorphine treatment initiation, engagement, and maintenance among commercially insured and MA enrollees with OUD.

Original language	English (US)
Pages (from-to)	393-401
Number of pages	9
Journal	Medical care
Volume	59
Issue number	5
DOIs	https://doi.org/10.1097/MLR.0000000000001530
State	Published - May 2021

Keywords

Medicare Advantage
buprenorphine
commercial insurance
opioid use disorder
quality
treatment

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

Access to Document

10.1097/MLR.0000000000001530

Cite this

@article{afe45b03d641454f8048b2e5aa3d4de3,

title = "Quality of Buprenorphine Care for Insured Adults with Opioid Use Disorder",

abstract = "Aim: The aim of this study was to characterize quality of buprenorphine care for opioid use disorder (OUD) by quantifying buprenorphine initiation, engagement, and maintenance for individuals in a large, diverse, real-world cohort in the United States. Design: This was a retrospective cohort analysis. Setting: OUD treatment in the outpatient setting. Participants: A total of 45,210 commercially insured and Medicare Advantage (MA) enrollees 18 years or older in the OptumLabs Data Warehouse with an index diagnosis of OUD between January 1, 2018 and December 31, 2018. Interventions: Treatment with buprenorphine. Measurements: We calculated 6 measures of buprenorphine treatment quality. We conducted survival analyses to characterize treatment duration and logistic regressions to evaluate the association between clinical and sociodemographic characteristics and quality. Findings: Of 45,210 eligible individuals with OUD, ~1 in 10 (n=4600, 10.2%) initiated buprenorphine within 365 days following diagnosis (Measure #1) and 2850 individuals (6.3%) initiated buprenorphine within 14 days of diagnosis (Measure #2). Of individuals initiating treatment within 14 days of diagnosis, 1769 (62.1%) had 2 or more buprenorphine claims within 34 days of initiation (Measure #3). Of the 4600 individuals who received buprenorphine, 2300 (50.0%) were maintained in care with 180 days or more of covered buprenorphine treatment during 365 days after diagnosis (Measure #4). Finally, of the 4600 individuals who received buprenorphine, 2543 (55.3%) did not fill any other concurrent opioid analgesic (Measure #5) and 2951 (64.2%) did not fill any concurrent benzodiazepine (Measure #6). Quality was generally lower for individuals with MA compared with commercial coverage and among Hispanic and Black adults compared with White adults. Conclusion: Widespread gaps exist in quality of buprenorphine treatment initiation, engagement, and maintenance among commercially insured and MA enrollees with OUD.",

keywords = "Medicare Advantage, buprenorphine, commercial insurance, opioid use disorder, quality, treatment",

author = "Anderson, {Kelly E.} and Brendan Saloner and Julia Eckstein and Chaisson, {Christine E.} and Scholle, {Sarah H.} and Lauren Niles and Sydney Dy and Alexander, {G. Caleb}",

note = "Funding Information: Supported in part by grant number T32HS000029 from the Agency for Healthcare Research and Quality and grant number K01DA042139 from the National Institute on Drug Abuse. The content is solely the respon-sibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institute on Drug Abuse. Publisher Copyright: {\textcopyright} 2021 Lippincott Williams and Wilkins. All rights reserved.",

year = "2021",

month = may,

doi = "10.1097/MLR.0000000000001530",

language = "English (US)",

volume = "59",

pages = "393--401",

journal = "Medical care",

issn = "0025-7079",

publisher = "Lippincott Williams and Wilkins",

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TY - JOUR

T1 - Quality of Buprenorphine Care for Insured Adults with Opioid Use Disorder

AU - Anderson, Kelly E.

AU - Saloner, Brendan

AU - Eckstein, Julia

AU - Chaisson, Christine E.

AU - Scholle, Sarah H.

AU - Niles, Lauren

AU - Dy, Sydney

AU - Alexander, G. Caleb

N1 - Funding Information: Supported in part by grant number T32HS000029 from the Agency for Healthcare Research and Quality and grant number K01DA042139 from the National Institute on Drug Abuse. The content is solely the respon-sibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institute on Drug Abuse. Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved.

PY - 2021/5

Y1 - 2021/5

N2 - Aim: The aim of this study was to characterize quality of buprenorphine care for opioid use disorder (OUD) by quantifying buprenorphine initiation, engagement, and maintenance for individuals in a large, diverse, real-world cohort in the United States. Design: This was a retrospective cohort analysis. Setting: OUD treatment in the outpatient setting. Participants: A total of 45,210 commercially insured and Medicare Advantage (MA) enrollees 18 years or older in the OptumLabs Data Warehouse with an index diagnosis of OUD between January 1, 2018 and December 31, 2018. Interventions: Treatment with buprenorphine. Measurements: We calculated 6 measures of buprenorphine treatment quality. We conducted survival analyses to characterize treatment duration and logistic regressions to evaluate the association between clinical and sociodemographic characteristics and quality. Findings: Of 45,210 eligible individuals with OUD, ~1 in 10 (n=4600, 10.2%) initiated buprenorphine within 365 days following diagnosis (Measure #1) and 2850 individuals (6.3%) initiated buprenorphine within 14 days of diagnosis (Measure #2). Of individuals initiating treatment within 14 days of diagnosis, 1769 (62.1%) had 2 or more buprenorphine claims within 34 days of initiation (Measure #3). Of the 4600 individuals who received buprenorphine, 2300 (50.0%) were maintained in care with 180 days or more of covered buprenorphine treatment during 365 days after diagnosis (Measure #4). Finally, of the 4600 individuals who received buprenorphine, 2543 (55.3%) did not fill any other concurrent opioid analgesic (Measure #5) and 2951 (64.2%) did not fill any concurrent benzodiazepine (Measure #6). Quality was generally lower for individuals with MA compared with commercial coverage and among Hispanic and Black adults compared with White adults. Conclusion: Widespread gaps exist in quality of buprenorphine treatment initiation, engagement, and maintenance among commercially insured and MA enrollees with OUD.

AB - Aim: The aim of this study was to characterize quality of buprenorphine care for opioid use disorder (OUD) by quantifying buprenorphine initiation, engagement, and maintenance for individuals in a large, diverse, real-world cohort in the United States. Design: This was a retrospective cohort analysis. Setting: OUD treatment in the outpatient setting. Participants: A total of 45,210 commercially insured and Medicare Advantage (MA) enrollees 18 years or older in the OptumLabs Data Warehouse with an index diagnosis of OUD between January 1, 2018 and December 31, 2018. Interventions: Treatment with buprenorphine. Measurements: We calculated 6 measures of buprenorphine treatment quality. We conducted survival analyses to characterize treatment duration and logistic regressions to evaluate the association between clinical and sociodemographic characteristics and quality. Findings: Of 45,210 eligible individuals with OUD, ~1 in 10 (n=4600, 10.2%) initiated buprenorphine within 365 days following diagnosis (Measure #1) and 2850 individuals (6.3%) initiated buprenorphine within 14 days of diagnosis (Measure #2). Of individuals initiating treatment within 14 days of diagnosis, 1769 (62.1%) had 2 or more buprenorphine claims within 34 days of initiation (Measure #3). Of the 4600 individuals who received buprenorphine, 2300 (50.0%) were maintained in care with 180 days or more of covered buprenorphine treatment during 365 days after diagnosis (Measure #4). Finally, of the 4600 individuals who received buprenorphine, 2543 (55.3%) did not fill any other concurrent opioid analgesic (Measure #5) and 2951 (64.2%) did not fill any concurrent benzodiazepine (Measure #6). Quality was generally lower for individuals with MA compared with commercial coverage and among Hispanic and Black adults compared with White adults. Conclusion: Widespread gaps exist in quality of buprenorphine treatment initiation, engagement, and maintenance among commercially insured and MA enrollees with OUD.

KW - Medicare Advantage

KW - buprenorphine

KW - commercial insurance

KW - opioid use disorder

KW - quality

KW - treatment

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Quality of Buprenorphine Care for Insured Adults with Opioid Use Disorder

Abstract

Keywords

ASJC Scopus subject areas

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