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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 17 of 17 Research Studies DisplayedMeiselbach MK, Huskamp HA, Eddelbuettel JCP
Choice of high-deductible health plans among enrollees with a substance use disorder.
Researchers examined factors associated with the decision of individuals with substance use disorders (SUDs) to enroll in high-deductible health plans (HDHPs). They used de-identified administrative commercial claims and enrollment data from OptumLabs to identify individuals at employers that offered at least one HDHP and one non-HDHP plan. Their findings showed that a health reimbursement arrangement was associated with a higher probability of new and re-enrollment in an HDHP. Older enrollees with SUD were less likely to enroll in a new HDHP, while enrollees who were non-White, lower income, and in lower educational attainment census blocks were more likely to newly enroll. The researchers concluded that, given the emerging evidence that HDHPs may discourage SUD treatment, higher HDHP enrollment could exacerbate health disparities.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Huskamp HA, Eddelbuettel JCP .
Choice of high-deductible health plans among enrollees with a substance use disorder.
J Subst Use Addict Treat 2023 Nov; 154:209152. doi: 10.1016/j.josat.2023.209152.
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Keywords: Health Insurance, Substance Abuse, Behavioral Health
Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A
High-deductible health plans and nonfatal opioid overdose.
This study examined whether an employer offering a high-deductible health plan (HDHP) had an impact on nonfatal opioid overdose among commercially insured individuals with opioid use disorder (OUD) in the United States. The authors used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. They estimated the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. Across both groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. They found no association of HDHP with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD.
AHRQ-funded; HS000029.
Citation: Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A .
High-deductible health plans and nonfatal opioid overdose.
Med Care 2023 Sep; 61(9):601-04. doi: 10.1097/mlr.0000000000001886..
Keywords: Healthcare Costs, Health Insurance, Opioids, Substance Abuse, Behavioral Health
Maclean JC, McClellan C, Pesko MF
AHRQ Author: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
AHRQ-authored.
Citation: Maclean JC, McClellan C, Pesko MF .
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Gertner AK, Rotter JS, Holly ME
The role of primary care in the initiation of opioid use disorder treatment in statewide public and private insurance.
This observational study’s goal was to determine if individuals newly diagnosed with opioid use disorder (OUD) who saw a primary care provider (PCP) before or on the date of diagnosis had higher rates of medication treatment for OUD (MOUD). Claims data from Medicaid and a large private insurer in North Carolina from January 2014 to July 2017 was used. During the period from 2014 to 2017, the prevalence of diagnosed OUD increased by 47% among Medicaid enrollees and by 76% among the privately insured. Over the same time period the number of people with an OUD who received MOUD fell among both groups, while PCP involvement in treatment increased. The percent of Medicaid enrollees receiving buprenorphine from a PCP increased from 32% in 2014 to 39% in 2017. In the 12 months before being newly diagnosed, approximately 82% with Medicaid or private insurance had a PCP visit. There was no difference in receiving an MOUD with those who had not seen a PCP. However, there was a higher probability of receiving MOUD with a PCP, than seeing an emergency provider, but lower than seeing a behavioral health specialist or other provider type.
AHRQ-funded; HS025065.
Citation: Gertner AK, Rotter JS, Holly ME .
The role of primary care in the initiation of opioid use disorder treatment in statewide public and private insurance.
J Addict Med 2022 Mar-Apr;16(2):183-91. doi: 10.1097/adm.0000000000000860..
Keywords: Primary Care, Opioids, Substance Abuse, Behavioral Health, Health Insurance
Bailey SR, Marino M, Ezekiel-Herrera D
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
This study examined whether states that expanded Medicaid eligibility under the ACA had increased smoking quit rates, tobacco cessation medication orders, and greater health care utilization compared to patients in non-expansion states. The researchers used electronic health record (EHR) data from 219 community health centers (CHCs) in 10 states that expanded Medicaid as of January 2014. They identified patients aged 19-64 with tobacco use status in their records within six months prior to ACA Medicaid expansion and 1 or more visits. They found that patients in expansion states had increased adjusted odds of quitting, having a medication ordered and having follow-up visits compared to patients in non-expansion states.
AHRQ-funded; HS024270.
Citation: Bailey SR, Marino M, Ezekiel-Herrera D .
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
Nicotine Tob Res 2020 Jun;22(6):1016-22. doi: 10.1093/ntr/ntz087..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Substance Abuse, Medication, Medicaid, Policy, Healthcare Utilization, Access to Care, Health Insurance
Springer R, Marino M,, Bailey SR
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.
AHRQ-funded; HS024270.
Citation: Springer R, Marino M,, Bailey SR .
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
Addiction 2019 Oct;114(10):1775-84. doi: 10.1111/add.14667..
Keywords: Opioids, Medication, Substance Abuse, Medicaid, Practice Patterns, Health Insurance, Access to Care, Policy
Maclean JC, Pesko MF, Hill SC
AHRQ Author: Hill SC
Public insurance expansions and smoking cessation medications.
The authors examined public insurance expansion on use of smoking cessation medications. The Affordable Care Act expanded coverage of these medications with financing with Medicaid. Data was analyzed from retail and online pharmacies from 2011 to 2017, and the expansion increased smoking cessation prescriptions by 24% in new medication use.
AHRQ-authored.
Citation: Maclean JC, Pesko MF, Hill SC .
Public insurance expansions and smoking cessation medications.
Econ Inq 2019 Oct;57(4):1798-820. doi: 10.1111/ecin.12794..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Health Insurance, Medication, Substance Abuse, Medicaid
Peterson E, Busch S
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
This article reviews the history and measures benefits from the 2008 passing of the Mental Health Parity and Addiction Equity Act (MHPAEA). It led to significant improvements in mental health care coverage. Directions for future research are also discussed.
AHRQ-funded; HS017589.
Citation: Peterson E, Busch S .
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
Annu Rev Public Health 2018 Apr 1;39:421-35. doi: 10.1146/annurev-publhealth-040617-013603..
Keywords: Access to Care, Behavioral Health, Disparities, Health Insurance, Policy, Substance Abuse
Hartung DM, Johnston K, Geddes J
Buprenorphine coverage in the Medicare Part D program for 2007 to 2018.
This letter discusses a study which looked into coverage of buprenorphine for opioid use disorder (OUP) with Medicare. The majority of plans do cover the generic version. However, the number of plans which require previous authorization has increased over from 2007 to 2018. This may hamper treatment by primary care physicians.
AHRQ-funded; HS024227.
Citation: Hartung DM, Johnston K, Geddes J .
Buprenorphine coverage in the Medicare Part D program for 2007 to 2018.
JAMA 2019 Feb 12;321(6):607-09. doi: 10.1001/jama.2018.20391..
Keywords: Health Insurance, Medicare, Medication, Opioids, Substance Abuse
Zhang Y, Johnson P, Jeng PJ
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
This study examined the association between a first opioid prescription and high-risk opioid use in the 18 months following the first prescription. A retrospective cohort study was conducted using data from a large commercial insurance claims database for patients aged 18-64 and also Medicare Advantage patients aged 65 or older for 2011-2014. The patients initially had not used opioids. The features the researchers were looking for were: 1) opioid or benzodiazepine prescriptions overlapping 7 days or more, 2) opioid prescriptions overlapping for 7 days or more; 3) three or more prescribers of opioids; and 4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription. All of those features were strongly associated with high-risk use.
AHRQ-funded; HS021531.
Citation: Zhang Y, Johnson P, Jeng PJ .
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
J Gen Intern Med 2018 Dec;33(12):2156-62. doi: 10.1007/s11606-018-4628-y..
Keywords: Opioids, Substance Abuse, Medication, Risk, Medicare, Health Insurance
Friedman SA, Azocar F, Xu H
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
The purpose of the stud was to assess whether implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with: 1. Reduced differences in financial requirements (i.e., copayments and coinsurance) for substance use disorder (SUD) versus specialty mental health (MH) care and 2. Reductions in the level of cost-sharing for SUD-specific services.
AHRQ-funded; HS024866.
Citation: Friedman SA, Azocar F, Xu H .
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
Drug Alcohol Depend 2018 Sep 1;190:151-58. doi: 10.1016/j.drugalcdep.2018.06.008..
Keywords: Behavioral Health, Health Insurance, Policy, Substance Abuse
Andrews CM, Grogan CM, Smith BT
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
This study looked at the effects the Affordable Care Act (ACA) had on Medicaid benefits for addiction treatment. The ACA established a minimum standard of benefits and required state Medicaid programs to make changes to their treatment benefits. Researchers surveyed all 50 states and the District of Columbia in 2014 and 2017 when the ACA requirements came into effect. There was a substantial increase in benefits with a decrease in annual service limits of over 50 percent. There was a large reduction in preauthorization requirements for medications to treat opioid use disorder as well as other reductions in preauthorizations.
AHRQ-funded; HS000084.
Citation: Andrews CM, Grogan CM, Smith BT .
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
Health Aff 2018 Aug;37(8):1216-22. doi: 10.1377/hlthaff.2018.0272..
Keywords: Access to Care, Behavioral Health, Health Insurance, Medicaid, Policy, Substance Abuse
Tran Smith B, Seaton K, Andrews C
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
This study assessed the extent to which state insurance departments regulate the types of substance use disorder (SUD) treatment that services and medications plans must provide, and also their use of utilization controls. Data were obtained from state insurance departments via an internet-based survey, as part of the National Drug Abuse Treatment System Survey. The results indicate that states vary widely in regulations on qualified health plans’ (QHPs) administration of SUD treatment benefits; some required plans to cover all the SUD treatment services and medications assessed in this study, while others did not require plans to cover any at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance on their usage. The authors conclude that by not requiring coverage for the entire SUD continuum of care, some states hinder client access to the appropriate types of care needed for recovery.
AHRQ-funded; HS000084.
Citation: Tran Smith B, Seaton K, Andrews C .
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
Am J Drug Alcohol Abuse 2018;44(4):426-30. doi: 10.1080/00952990.2017.111934..
Keywords: Access to Care, Health Insurance, Medication, Policy, Substance Abuse
Friedman S, Xu H, Harwood JM
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
The purpose of this study was to determine whether Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with increased behavioral health expenditures and utilization among a population with substance use disorder (SUD) diagnoses. The investigators found that MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Harwood JM .
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
J Subst Abuse Treat 2017 Sep;80:67-78. doi: 10.1016/j.jsat.2017.06.006..
Keywords: Behavioral Health, Healthcare Costs, Healthcare Utilization, Health Insurance, Policy, Health Services Research (HSR), Substance Abuse
Creedon TB, Cook BL
Access to mental health care increased but not for substance use, while disparities remain.
The researchers assessed whether early implementation of Affordable Care Act (ACA) Medicaid expansion and state health insurance exchanges increased access to mental health and substance use treatment among those in need and whether these changes differed by racial/ethnic group. They found that mental health treatment rates increased significantly but found no evidence of a reduction in the wide racial/ethnic disparities in mental health treatment that preceded ACA expansion from 2005 to 2013.
AHRQ-funded; HS021486.
Citation: Creedon TB, Cook BL .
Access to mental health care increased but not for substance use, while disparities remain.
Health Aff 2016 Jun;35(6):1017-21. doi: 10.1377/hlthaff.2016.0098.
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Keywords: Access to Care, Disparities, Health Insurance, Policy, Medicaid, Behavioral Health, Substance Abuse
Montz E, Layton T, Busch AB
Risk-adjustment simulation: plans may have incentives to distort mental health and substance use coverage.
The authors examined health plan incentives to limit covered services for mental health and substance use disorders under the risk-adjustment system used in the health insurance Marketplaces. They documented how Marketplace risk adjustment does not remove incentives for plans to limit coverage for services associated with mental health and substance use disorders.
AHRQ-funded; HS000055.
Citation: Montz E, Layton T, Busch AB .
Risk-adjustment simulation: plans may have incentives to distort mental health and substance use coverage.
Health Aff 2016 Jun;35(6):1022-8. doi: 10.1377/hlthaff.2015.1668.
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Keywords: Health Insurance, Policy, Behavioral Health, Substance Abuse
Saloner B, Le Cook B
An ACA provision increased treatment for young adults with possible mental illnesses relative to comparison group.
The researchers examined the impact of the ACA dependent coverage provision on people ages 18-25 with possible mental health or substance use disorders. They found that after implementation of the ACA provision, among people ages 18-25 with possible mental health disorders, mental health treatment increased by 5.3 percentage points relative to a comparison group of similar people ages 26-35. For those using mental health treatment, uninsured visits declined by 12.4 percentage points, and visits paid by private insurance increased by 12.9 percentage points.
AHRQ-funded; HS021486.
Citation: Saloner B, Le Cook B .
An ACA provision increased treatment for young adults with possible mental illnesses relative to comparison group.
Health Aff 2014 Aug;33(8):1425-34. doi: 10.1377/hlthaff.2014.0214.
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Keywords: Access to Care, Health Insurance, Behavioral Health, Substance Abuse, Young Adults