Despite the increasing value state Medicaid programs place on data analytics, including multi-state Medicaid comparisons to inform evidence-based state health policy, significant barriers exist to sharing this data between states. AcademyHealth, in collaboration with a Data Coordinating Center at the University of Pittsburgh, established the Medicaid Outcomes Distributed Research Network (MODRN) to conduct effective multi-state analyses aimed at addressing issues of state and national priority, while also maintaining their state’s data privacy standards. The initial MODRN project provides a comprehensive assessment of opioid use disorder (OUD) treatment quality and outcomes in Medicaid. As states consider future multi-state Medicaid issues to examine multi-state utilizing MODRN, AcademyHealth, supported by the Ohio Colleges of Medicine’s Government Resource Center, talked to 22 states Medicaid agencies and identified four shared state-federal Medicaid policy priorities for future multi-state analysis: substance use disorder, behavioral health integration, maternal mortality, and social determinants of health.
Given the broad scope of these policy priorities, university researchers and state Medicaid representatives assisted in distilling specific research topics and questions within each policy priority in accordance with their state’s most pressing issues to develop salient suggestions for multi-state Medicaid analyses.
Substance Use Disorder
States expressed interest in exploring substance use disorder (SUD) projects that looked at prior authorization policies and their impacts on treatment rates, as well as how SUD relates to neonatal abstinence syndrome (NAS). States with 1115 Institutions for Mental Disease (IMD) waivers were also interested in utilizing the MODRN framework to compare IMD waiver activity. States also recommended that future multi-state substance use disorder-related projects focus on specific populations, such as perinatal mothers and justice-involved populations.
Behavioral Health Integration
States specified interests in projects that focused on integrating behavioral health into primary care, comparing outcomes between populations served under behavioral health carve-ins versus carve-outs, and how different reimbursement models facilitate care coordination between primary care and behavioral health. Notably, states highlighted that when discussing behavioral health integration, their efforts focused on broader mental health issues rather than substance use disorder specifically. Furthermore, states identified children in foster care and the adolescent population as primary populations of interests for behavioral health integration research.
States were primarily interested in projects centered on prenatal care, focused on how to track early and effective prenatal care to measure maternal outcomes. States were also interested in measuring the impact of extended postpartum Medicaid coverage on maternal mortality and morbidity. In addition, many states indicated an interested in pursuing a project that links Medicaid claims to vital statistics data.
Social Determinants of Health
While social determinants cuts across a wide variety of different policy areas, states were specifically interested in addressing housing and family/community stability, which many have built into their state’s 1115 Demonstration waiver. Particularly, states were interested in multi-state analyses focused on reviewing approaches for identifying social determinants in claims data and policies that increase cross enrollment among other public benefit programs. While overall states were interested in linking Medicaid with other social services datasets, they varied in their capacity to do so. Furthermore, while many states reported using spatial analysis tools to geo-code Medicaid recipients, they varied in the tools used. Finally, respondents discussed that they were not utilizing ICD-10 Z-codes recently developed to classify patients’ social determinants due to lack of clarity of the codes and lack of population. This shared state interest, coupled with the varying capacity to initiate such work, underscored the value in utilizing MODRN to coordinate an SDH focused multi-state effort.
Medicaid provides health care coverage to over 70 million Americans, giving the program unique leverage to make significant impacts on individuals, communities and the United States health care system at large. MODRN allows states the capacity to conduct timely and effective multi-state analysis to support evidence-based state health policy through the shared learnings from their multi-state counterparts. We look forward to building on the learnings from the MODRN-OUD project, to harness the MODRN to meet the expressed priorities of state Medicaid agencies to ultimately improve services and improve health and health care.