Stakeholder engagement to inform provider-level opioid use disorder quality measurement in Medicaid

Background Medicaid finances nearly half of treatment for opioid use disorder (OUD) in the United States, yet few states have adopted a comprehensive approach to measuring the quality of OUD treatment. Moreover, a lack of provider-level measures and limited integration of patient-reported outcomes impedes OUD quality measurement and improvement efforts. To address this gap, we conducted listening sessions and a ranking exercise to assess stakeholder perceptions of the acceptability, feasibility, and usefulness of several OUD quality measures for Medicaid patients, providers, and payers. Methods We sought input from four stakeholder groups: lived experience panelists, OUD treatment providers, Medicaid managed care organizations’ Chief Medical Officers (MCO CMOs), and Medicaid Medical Directors (MMDs). Listening sessions, held with lived experience panelists and MMDs, solicited input on (1) OUD treatment provider roles and responsibilities, (2) perceptions of what constitutes high-quality care, and (3) OUD treatment experiences. Qualitative methods followed the Consolidated Criteria for Reporting Qualitative Research guidelines. Treatment providers, MCO CMOs, and MMDs participated in the modified Delphi process to add, edit, and rank 16 provider-level OUD quality measures based on 5 criteria: (1) provider influence, (2) acceptability, (3) feasibility, (4) patient choice of provider, and (5) use for performance assessment. Results Analyses of listening session data with lived experience panelists and MMDs ( n = 20) identified five themes: (1) empathic and respectful OUD treatment settings; (2) provider stigma hindering effective OUD treatment; (3) insufficient provider and treatment choices (i.e., medication types and peer support) for individuals with OUD; (4) importance of structured peer support; and (5) whole-person, team-based care for individuals receiving OUD treatment. The participants in the modified Delphi activity ( n = 30) ranked the following measures highest on all 5 criteria: “proportion of the provider’s patients with OUD receiving MOUD,” and “proportion of provider’s patients with a residential treatment episode for OUD that have an outpatient visit within 30 days after discharge.” Patient-reported outcome measures (“proportion of patients treated with respect”) ranked highly on value for patient choice and provider influence but lower on other criteria, such as feasibility. Conclusions Stakeholders emphasized empathy and person-centered care as core tenets of high-quality OUD care. Only select provider-level quality measures were ranked highly across all criteria. Claims-based quality measures were ranked highly on more criteria, even though patient-reported outcomes ranked highly for determining patient choice. Trial registration (Not applicable).