RTI study highlights need to improve opioid use disorder treatment for Medicare beneficiaries

Less than 40 percent of Medicare beneficiaries with opioid use disorder received care that meets national quality standards

RESEARCH TRIANGLE PARK, N.C. — Older Americans have experienced a significant rise in drug overdose deaths. A new study published in Health Affairs by researchers at the independent scientific research institute RTI International shows that Medicare, the primary insurer for this age group, is not consistently meeting national standards for opioid use disorder (OUD) treatment. 

The analysis found that fewer than 40 percent of Medicare beneficiaries with OUD received care aligned with nationally recognized quality measures in 2020. The findings also revealed that only 29 percent of beneficiaries initiated treatment within two weeks of diagnosis and just 11 percent engaged in ongoing care within the first month. Despite recent policy efforts, including expanded coverage for methadone and outpatient services, the study highlights persistent gaps in care.

“Opioid use disorder is prevalent among Medicare beneficiaries, yet the majority are not receiving care that meets nationally recognized standards,” said lead author Tami L. Mark, Ph.D., M.B.A., Distinguished Fellow and director of Behavioral Health Financing and Quality Measurement at RTI. “This gap in treatment quality underscores the need to disseminate quality measures for opioid use disorders in Medicare Advantage and traditional Medicare, as is done for Medicaid programs.”

Using Medicare enrollment, claims and encounter data from 2019 and 2020, RTI researchers calculated eight validated opioid use disorder treatment metrics. These include timely initiation and engagement in treatment, follow-up after emergency department and hospital visits, and use and continuity of medications to treat opioid use disorders.

William Parish, Ph.D., a co-author from RTI, said, “While publishing quality measures is an important step to help drive improvements in Medicare’s delivery of opioid use disorder treatment, barriers such as prior authorization policies, a lack of providers willing to treat addiction and Medicare beneficiaries’ uncertainty about the need for treatment may be contributing to low treatment rates.”

The study also found disparities across subpopulations. Medicare Advantage performed worse than traditional fee-for-service Medicare on six of the eight measures. Medicare performed worse than Medicaid on all three quality measures available for comparison. Beneficiaries dually eligible for Medicare and Medicaid had higher rates of quality care than those not dually eligible. Younger beneficiaries under the age of 65 received higher-quality care than older adults on six of the eight measures.

Read the full study

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