Housing

• Changes in Medicaid Utilization and Spending Associated with Homeless Adults' Entry into Permanent Supportive Housing

  • Three years after permanent supportive housing (PSH) entry, spending decreased by an average of $145/month in the PSH cohort relative to changes in the comparison cohort, with the greatest relative spending reductions occurring for residential behavioral health, inpatient non-behavioral health services, ED use and inpatient hospital stays.

• Permanent Supportive Housing and Medicaid Utilization and Spending in Pennsylvania October 2019

  • The analysis of chronically homeless Pennsylvania Medicaid enrollees found that entry into permanent supportive housing (PSH) was associated with long-term decreases in inpatient and ED utilization, as well as reduced Medicaid expenditures relative to enrollees who did not receive PSH. 

 Pharmaceuticals

• Initial Opioid Prescribing and Subsequent Opioid Use After Dental Procedures Among Opioid Naive Patients in Pennsylvania Medicaid, 2012 to 2017

  • Although enrollees undergoing high-pain dental procedures were more likely to fill an initial opioid prescription than their counterparts with low- to moderate-pain procedures, the relative risk of sustained opioid use (4-90 days post-procedure) was highest in the low-pain group.

• Patient, physician and organizational influences on variation in prescribing behavior: evidence from antipsychotic medications in a large Medicaid program

  • The concentration of antipsychotic choice among individual psychiatrists in a large state Medicaid program varied substantially. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient which may limit treatment options for patients. 

• Prescribing of Clozapine and Antipsychotic Polypharmacy for Schizophrenia in a Large Medicaid Program

  • Considerable variation was found in clozapine and antipsychotic polypharmacy practices across prescribers in their treatment of schizophrenia. Targeting efforts to selected prescribers holds promise as an approach to promote evidence-based antipsychotic prescribing.

• Trajectories of Diabetes Medication Adherence and Hospitalization Risk

  • Oral hypoglycemic treatment trajectories were highly variable in this large Medicaid cohort. Individuals with low and moderate adherence and those filling only one prescription had a modestly higher risk of hospitalizations/ED visits compared to those with perfect adherence. 

• Long-term disease and economic outcomes of prior authorization criteria for Hepatitis C treatment in Pennsylvania Medicaid

  • Expansion of hepatitis C virus (HCV) treatment coverage to less severe stages of liver disease may not substantially improve liver related outcomes for patients in Pennsylvania Medicaid in scenarios in which coverage through Medicare is widely available.

• Provider and Patient-panel Characteristics Associated With Initial Adoption and Sustained Prescribing of Medication for Opioid Use Disorder

  • MOUD prescribing adoption was concentrated among PCPs prescribing mental health medications, caring for those with OUD, and new Medicaid providers. These results should be leveraged to test/implement interventions targeting MOUD adoption among PCPs.

 Behavioral Health

• Medical Specialty of Buprenorphine Prescribers for pregnant Women with Opioid Use Disorder

  • Few obstetricians/gynecologists prescribe buprenorphine for Medicaid-enrolled pregnant women with opioid use disorder. In rural areas, emergency medicine providers accounted for nearly 1 in 10 buprenorphine prescribers. Future research should evaluate whether obstetric providers can decrease barriers to MAT for pregnant women by prescribing buprenorphine, particularly in rural areas.

• Adherence Trajectories of Buprenorphine Therapy among Pregnant Women in a Large State Medicaid Program in U.S. 

  • Six distinct buprenorphine treatment trajectories during pregnancy were identified in this population-based Medicaid cohort, with 25% of women initiating buprenorphine late during pregnancy. Understanding trajectories of buprenorphine use and factors associated with discontinuation/nonadherence may guide integration of behavioral treatment with obstetrical/gynecological care to improve buprenorphine treatment during pregnancy.

• The Role of Primary Care in Improving Access to Medication-Assisted Treatment for Rural Medicaid Enrollees with Opioid Use Disorder

  • PCP utilization among rural Medicaid enrollees diagnosed with opioid (OUD) is high, presenting a potential intervention point to treat OUD, particularly if travel time to the enrollee's PCP is shorter than to other potential addiction treatment providers. 

• Prescription Opioid Quality Measures Applied Among Pennsylvania Medicaid Enrollees

  • Prevalence of high-dosage opioid use was 5.5%, multiple opioid prescribers/pharmacies was 5% and concurrent use of opioids and benzodiazepines was 28.4% among Medicaid enrollees filling >2 opioids. High levels of disability eligibility and comorbid behavioral health conditions in those with high-risk opioid use point to the need for multi-disciplinary approaches to improving the quality of pain treatment.

• Patterns and Quality of Buprenorphine Opioid Agonist Treatment in a Large Medicaid Program

  • Increases in buprenorphine treatment in a Medicaid population were observed across time. However, increases varied by age, sex, and race/ethnicity, and the quality of care received seemed to be generally poor pointing to the need for quality improvement efforts.

• Associations between Trajectories of Buprenorphine Treatment and Emergency Department and Inpatient Utilization

  • Among adults initiating buprenorphine treatment, 69.3% discontinued at some point in the first 12 months, 9.5% refilled intermittently, and 21.2% refilled persistently for 12 months. Those refilling persistently had 18% lower risk of hospitalizations and 14% lower risk of emergency departments in the following year.  Health systems should adopt interventions to improve the duration of buprenorphine treatment. 

• Medication-assisted treatment and opioid use before and after overdose in Pennsylvania Medicaid

  • This study used Medicaid data to compare prescription opioid use, duration of opioid use, and rates of medication-assisted treatment (buprenorphine, methadone, or naltrexone) among enrollees before and after a non-fatal overdose event. Relatively small changes in opioid prescribing and receipt of medication-assisted treatment point to a relatively weak health system response to a life-threatening event.

• Medicaid Prior Authorization and Opioid Medication Abuse and Overdose

  • Enrollees within Medicaid plans that utilize prior authorization policies for opioid analgesics appear to have lower rates of abuse and overdose following initiation of opioids.

• An Examination of Claims-based Predictors of Overdose from A Large Medicaid Program

  • Claims-based measures can be used by health systems to identify individuals at-risk of overdose who can be targeted for restrictions on opioid prescribing, dispensing, or referral to treatment.

• Predicting Mortality Risk After a Hospital or Emergency Department Visit for Nonfatal Opioid Overdose

  • A risk prediction model performed well for classifying mortality risk after a nonfatal opioid overdose. This prediction score can identify high-risk subgroups to target interventions to improve outcomes among overdose survivors although a number of challenges to implementing risk prediction models remain.

• Patterns of clinic switching and continuity of medication for opioid use disorder in a Medicaid-enrolled population

  • It was common for Medicaid enrollees receiving medications for opioid use disorder to switch providers during treatment, however, provider switching was not associated with elevated risk of overdose or reductions in adherence. Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions.

• Opioid Prescribing Safety Measures in Medicaid Enrollees With and Without Cancer

  • Individuals with cancer, regardless of treatment status, had higher-risk opioid use based on Pharmacy Quality Alliance measures versus those without cancer. Their systematic exclusion from opioid quality surveillance could create missed opportunities to identify patients at high risk of adverse opioid-related outcomes.

• Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018

  • Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder (OUD) increased from 2014 through 2018. Some indicators of quality improved while others did not. There was variation in any use and in duration of medications for OUD by age, race/ethnicity and eligibility group) 

• Healthcare patterns of pregnant women and children affected by OUD in 9 state Medicaid populations

  • There were modest increases in rates of medication use for opioid use disorder in pregnant women in 9 state Medicaid programs from 2014 to 2017. There was substantial variation in continuity of medication use and in receipt of well-child visits among children diagnosed with neonatal abstinence syndrome across states.

 Maternal and Child Health

• Rethinking How to Measure the Appropriateness of Cervical Cancer Screening

  • Changing cervical cancer screening performance measures to align better with clinical guidelines will help reduce the frequency of unnecessary procedures and more accurately measure the quality of women’s health care.

• Cervical Cancer Screening Guideline Adherence Before and After Guideline Changes in Pennsylvania Medicaid

  • We observed high rates of cervical cancer over-screening and under-screening and low rates of appropriate screening after the guideline change. Interventions should target both underscreening and overscreening to address these separate yet significant issues.

• Screening for Sexually Transmitted Infections After Cervical Cancer Screening Guideline and Medicaid Policy Changes: A Population-based Analysis

  • STI screening dramatically increased between 2007 and 2011. Potential reasons are family planning program implementation, increased urine/vaginal testing, and reporting improvements. Between 2011 and 2013, rates stabilized at 45% among all women and 60% among sexually active women below 25 years, suggesting opportunities for improvement.

• Prescriptions for Opioids After Vaginal Delivery

  • More than 1 in 10 Medicaid-enrolled women filled an outpatient opioid prescription after non-complicated vaginal delivery. National opioid-prescribing recommendations for common obstetrics procedures such as vaginal delivery are warranted.

• Medical specialty of buprenorphine prescribers for pregnant women with opioid use disorder

  • Few obstetricians/gynecologists prescribe buprenorphine for Medicaid-enrolled pregnant women with opioid use disorder. In rural areas, emergency medicine providers accounted for nearly 1 in 10 buprenorphine prescribers. Future research should evaluate whether obstetric providers can decrease barriers to medication treatment for pregnant women by prescribing buprenorphine, particularly in rural areas.

• Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure

  • Children with in-utero opioid exposure had a lower predicted probability of recommended well-child visit use at age fifteen months compared to those with tobacco exposure and those with neither exposure. Children with in-utero opioid exposure had a predicted probability of being diagnosed with a pediatric complex chronic condition similar to that among children with tobacco exposure and those with neither exposure.

 Long-Term Care

• Home- and Community-Based Provider Preparation for Pennsylvania's Managed Long-term Services and Supports

  • Providers in the first implementation phase of Pennsylvania’s managed long-term services and supports had more strategic and operational discussions with MCOs than the other two phases. As program rollout continues, we anticipate changes in MCO-provider conversation frequency and topics based upon implementation zone.

• Community HealthChoices Evaluation Plan

  • The University of Pittsburgh is conducting a comprehensive multi-year evaluation of Pennsylvania's new Medicaid Long-Term Services and Supports program, Community HealthChoices (CHC). The evaluation is providing an independent assessment of the implementation and outcomes of the program to complement other oversight and quality assurance activities conducted by the Department of Human Services, Office of Long-Term Living.

 Acute Care Utilization 

• Low-Value Diagnostic Imaging in Children with Medicaid

  • Among the studied conditions, more than 1 in 20 encounters included low-value imaging, mostly in non-pediatric EDs and for bronchiolitis, head trauma, and headache. Interventions are needed to decrease the future performance of these low-value services.

• Emergency Department and Ambulatory Care Visits in the First Twelve Months of Coverage Under Medicaid Expansion: A Group-Based Trajectory Analysis

  • Substantial variation in rates of ED and ambulatory care use across empirically defined subgroups of Medicaid expansion enrollees were found. Heterogeneity among the diagnoses associated with these visits was also identified. This data-driven approach may be used to target resources to encourage efficient use of ED services and support engagement with ambulatory care clinicians.

 Health Equity

• Disparities in Access to Primary Care and Emergency Department Utilization in a Large Medicaid Program

  • Disparity-reducing interventions should address region and MCO in addition to race, and should focus on post-Expansion trends. The state Medicaid program should consider these results in MCO recommendations and contracts.

• Prenatal and Postpartum Care Disparities in a Large Medicaid Program

  • The data demonstrate that interventions should address disparities by race, region, and MCO in equity-promoting measures.