Medicaid-funded MAT for OUD in the tri-county region

• 58% of current Health Share members with an OUD diagnosis between April 2018 and March 2019 received MAT services during this time period. 
• The percentage of people with  OUD receiving MAT services varies by county. Current rates are higher in Washington and Multnomah counties (59%) than in Clackamas (53%). 

Medication-assisted treatment (MAT) is an important part of an effective response to opioid use disorder (OUD) and has demonstrated success as part of treatment in reducing heroin use and prescription opioid misuse.  As a result, MAT can help decrease fatal and non-fatal overdoses, reduce transmission of infectious disease, increase treatment retention,  and improve social functioning. MAT is often unavailable to those in need of it because of inadequate funding for treatment programs and a lack of qualified providers who can deliver these therapies. The Tri-County Region is working to increase access to MAT by increasing the number of clinicians licensed to prescribe it in primary care, locating additional services in rural areas, and examining insurance coverage.

The following graph shows the percentage of Medicaid members with an OUD diagnosis who received MAT services, either through office-based opioid treatment (OBOT) or an Opioid Treatment Program (OTP). Health Share is tracking this indicator over time.

Note: MAT Services include both those derived from procedure codes and pharmacy claims.

Opioid Use Disorder was defined as having a diagnosis code (any field) on a claim during the specified time period. All F11 and opioid overdose codes were included. MAT services were defined either through a procedure code or a pharmacy code. Buprenorphine, methadone, suboxone, and naltrexone are included.  See Appendix for a complete list of codes.

The data source is Health Share of Oregon member claims. Health Share of Oregon is a Coordinated Care Organization (CCO) serving approximately 310,000 Medicaid members in the tri-county area.

Denominator: Members with an Opioid Use Disorder (OUD) diagnosis. Members were included in the denominator if they had at least one claim with a diagnosis of OUD during the specified time period. Members could only be included in the denominator once per time period, regardless of their number of claims with an OUD diagnosis. 

Numerator: Members with an OUD diagnosis who received MAT services. Members were included if they were in the denominator AND they had at least one claim during the time frame with either 1) An MAT procedure code OR 2) An MAT drug dispensed through a pharmacy claim.  Members could only be included in the numerator once per time period, regardless of their number of claims for MAT services. 

Limitations. These data capture only the members with a diagnosis of opioid use disorder.  They do not provide a complete picture of the members who could benefit from MAT (e.g. if the condition is undiagnosed).  Additionally, these data do not provide information on whether care received improved patient outcomes.  These data do not include commercially insured or uninsured individuals who live with opioid use disorder and who could benefit from MAT.

ICD-10 Codes for Opioid Use Disorder
F11 (any field) OR T40.0-4 (any field)

Procedure Codes for MAT: 
H0020, H0033 with HF or HG modifier, H0016, T1502 with HF or HG modifier, J0571, J0572, J0573, J0574, J2315

Pharmacy NDC Codes for MAT:

• HEDIS NDC medication list 'MAT for Opioid Abuse or Dependence Medications'
• Plus NDC 62756097083, BUPRENORPHINE HYROCHLORIDE 8mg/1 NALOXONE HYDROCHLORIDE DIHYDRATE 2mg/1 SUBLINGUAL TABLET.