Medicaid Outcomes Distributed Research Network

Historically, researchers have had difficulty comparing Medicaid data across states because privacy and security concerns prevent the data from being shared in real time. Yet, such comparisons are particularly crucial for understanding the impact that state-level Medicaid policies are having on the millions of people across the country who rely on this assistance to help cover their health and behavioral health expenses.

Thanks to an unprecedented approach to Medicaid research, practitioners and policymakers are another step closer to better understanding the quality of care provided across 11 states to Medicaid recipients seeking treatment for opioid use disorder (OUD). With support from the National Institutes on Drug Abuse, researchers in these states have formed the Medicaid Outcomes Distributed Research Network (MODRN) – a collaborative initiative that allows participating states to retain and analyze their Medicaid data and share the aggregated results in real time with their data partners.

Paul Lanier, Ph.D., the SSW’s Wallace Kuralt Early Distinguished Scholar and principal investigator for North Carolina’s MODRN site, is working with N.C. Medicaid, the Sheps Center’s Carolina Cost and Quality Initiative, and Anna Austin, Ph.D., assistant professor in UNC Gillings School of Global Public Health, to analyze and assess the effectiveness of OUD policies in North Carolina and beyond. Lanier’s team is especially interested in helping to shape North Carolina’s service goals and plans of care as the state transitions from a fee-for-service Medicaid system to a managed care system, where for-profit companies provide Medicaid services to North Carolinians.

The work of this 11-state consortium is particularly timely, given that the overlapping crises of the opioid epidemic and the COVID-19 pandemic dramatically reshaped accessibility to opioid treatment programs nationwide, including shifting patients toward telehealth services. So how did such a shift impact individuals in need of treatment programs? In a study of the effects of telehealth services on OUD treatment outcomes across the 11-state network, Lanier and his colleagues found that the longer Medicaid patients take medication to treat opioid use, the less likely they are to overdose.

Although medication treatment for OUD remains controversial in some recovery and policy communities, the study’s findings offer powerful justification for these treatment programs, Lanier explained.

“Some people have concerns that these medications are substituting one drug for another,” Lanier said. “But our data shows that people who have access to these evidence-based medications over the long-term are much less likely to experience an overdose” and more likely to live longer in recovery.

At the same time, the study’s analysis revealed that across the 11 participating states, Black Medicaid enrollees with OUD are 28% less likely than their White counterparts to receive medication treatments and 11% less likely to receive such treatments for at least six months. Based on these findings, Lanier’s research team has advocated for financial incentives to be included in contracts between the state and private managed care companies to strengthen Black North Carolinians’ access to Medicaid supported treatment services.

In addition, Lanier and Orrin Ware, Ph.D., SSW assistant professor, are also beginning to study causes of racial and ethnic inequities in medication-assisted OUD treatment. Their study, which is supported by a five-year, $338,000 grant from the National Institute on Drug Abuse, aims to identify effective policies that improve equity in treatment access. Ware is optimistic about the project’s prospects.

“All North Carolinians deserve access to essential and effective substance use disorder treatment,” he said. “This research will give clinicians and policymakers the knowledge base they need to remove structural barriers and make equity a reality.”