Brandeis-Harvard SPIRE Center

Center Research

 The Center builds on 3 component research projects, as well as related research at Brandeis, Harvard and elsewhere, and supports the development of new research to provide crucial and timely research evidence that can inform the design and implementation of effective policies.

Examining Opioid Use Disorder Treatment in Medicaid Managed Care Plans

The opioid crisis is a critical issue for state Medicaid programs, as nearly 40% of people with OUD nationally are Medicaid beneficiaries.Health plans have discretion in several areas including coverage, utilization management, network management, and provider payment. However, available information on their policies related to OUD services is minimal. This study systematically examines MMCO delivery and management of OUD treatment using a national survey.

The aims are to: 1) describe OUD treatment policies across MMCOs and identify state policies and market and plan characteristics associated with these policies; 2) evaluate the relationship between OUD policies and plan-level rates of access to and quality of OUD treatment using NCQA data; and, 3) assess the relationship between OUD policies and patient-level treatment and outcomes (e.g., MOUD duration, overdose) using Medicaid claims from three states.

The project integrates with the Center theme through its focus on Medicaid and how MMCO policies influence delivery system approaches.

Hub and Spoke Opioid Treatment Networks: 2nd Generation Approaches to Improve MOUD

MOUD remains an underutilized evidence-based practice. Washington State has implemented a hub and spoke model (H&S) to expand access to MOUD that incorporates primary care and SUD treatment programs, nurse care managers, and care navigators. A low-barrier opioid treatment network (OTN) model was later developed to place MOUD initiation sites in low-barrier settings such as emergency departments, syringe exchanges, and jails, with connections to community partners for maintenance MOUD.

The aims are to: 1) examine the implementation and effectiveness of these models; 2) conduct a social network analysis among all H&S/OTN networks to describe patterns of connection, coordination, and integration among organizations; and, 3) test the relationships between network features and model effectiveness.

This project integrates with the Center theme, primarily around delivery systems that involve low-barrier settings, access to care, and quality, as well as sustainability of innovative approaches.

Medications for Alcohol Use Disorder: Unfilled Prescriptions and Treatment Trajectories

Many individuals with alcohol use disorder (AUD) receive no treatment, including evidence-based pharmacotherapies. Previous research on AUD medication use has primarily relied on claims data, so it is not possible to distinguish the characteristics of individuals who do not receive a prescription from a clinician from those who receive one but do not fill it. Using linked claims and electronic health record (EHR) data, as well as interviews of AUD providers, we will:

1) identify patient and provider characteristics associated with being prescribed an AUD medication; 2) identify patient and prescriber characteristics associated with filling the prescription; and 3) identify trajectories of AUD care that incorporate information on prescriptions written for individuals diagnosed with AUD, and examine the association between treatment trajectories and indicators of subsequent relapse and injury.

The findings will help pinpoint where in the treatment process different types of people fall out of treatment and how different treatment trajectories are associated with relapse and injury, informing future intervention and policy design. This project relates to the Center theme by focusing on systems issues that affect diffusion of an evidence-based treatment.