Since the mid-nineties, the United States has been dealing with the ramifications of an opioid epidemic that has devastated vast swaths of our population, cutting across all demographics.
Those responsible for overseeing each state’s Medicaid program have a tough task in meeting the needs of people, managing the availability of services, controlling costs, and operating in a highly regulated environment. The good news is that while there are some rigid compliance requirements put upon states by the Center of Medicaid Services (CMS), Section 1115 demonstration waivers provide states with a way to test new approaches in Medicaid that differ from what is required by federal statute.
These waivers can provide considerable flexibility in how each state operates their programs, and generally reflect priorities identified by states and the Center of Medicaid Services (CMS), as well as changing priorities and acute care needs facing individual states. In many, one of those acute care conditions includes handling ailments related to Substance Abuse Disorder (SUD), specifically those resulting from opioid abuse.
One state in the Midwest faced significant levels of SUD.
Home to well over 11 million people, this state has an estimated 2.8 million people subscribed to Medicaid – more than a quarter of its population. The FY2020 budget for Medicaid alone here is $29.1 billion, with $9.9 billion coming from the state. While these are big numbers, the most important and most impactful numbers are the effect that opioid abuse has had on the state and its people.
At its height, about 5,000 people died from opioid overdoses each year in this state alone. Additionally, it costs the state an estimated $5 billion dollars a year in treatment, criminal justice, social services, and lost economic productivity.
35% of all criminal charges against women in the state are substance-abuse related, and in social services, “70% of the children in the child welfare programs have opioid-involved parents, and it is overwhelming the system.”
Improving Access to Aid in Recovery
The state’s Medicaid services is committed to making sure those most in need have access to the medical, mental health, and support services they need to recover, rebuild their lives, and return to becoming productive members of society.
To aid this effort, the state put together a Section 1115 waiver designed to take a more proactive approach to their SUD issues, including improving access to prevention, treatment, and recovery support services, including inpatient addiction services. A significant part of this approach was to take an evaluation of what SUD-related services were available, what types of services were being utilized, and how far away these services were from those who needed it. The operating hypothesis was that the further recipients were away from services, the less likely it was they would seek or get treatment.
To secure this waiver, they needed to measure and analyze was how many SUD-related services were available within the state, and more importantly, how convenient these services were to those who needed them. In other words, were the needed services within easy driving distance for populations with SUD-related ailments?
To undertake such analysis, they had to compile a vast number of different points of data, including the number and percentage of individuals enrolled in Medicaid with a SUD diagnosis. Additionally, they needed to understand the number and percentage of individuals with Medicaid using critical Levels of Care (LOC), including early intervention, outpatient services, intensive outpatient and partial hospitalization services, residential and inpatient services, withdrawal management, and management after treatment. They also needed to compile information on medical service claims, facility claims, pharmacy claims, and mental health claims related to SUD treatment.
Another significant part of the analysis was the distribution of services by qualified providers. This analysis included looking at the number and percentage of providers enrolled in Medicaid and qualified to deliver SUD-related services. This also included the number and percentage of qualified providers who could provide critical LOC, including early intervention, outpatient services, intensive outpatient and partial hospitalization services, residential and inpatient services, withdrawal management, and ongoing support services.
Additionally, they wanted to join this data with demographic information related to 2.8 million Medicaid subscribers, millions of lines of data related to specific claim types, 5.2 million residential housing locations, and over 300,000 service provider locations. With all this varied data, they wanted to create a geospatial analysis that would create a deep level of insight into the availability and distribution of SUD-related services and measure how convenient they were to Medicaid subscribers within the state.
Identifying Gaps to Improve Resource Allocation
The state needed an analytics platform that could handle the volume and variety of data and provide geospatial analysis to inform policy makers and providers with a robust array of insight on where critical gaps in LOC may exist. Once they selected the right one, the insights gained enabled the state to work with Managed Care Organizations (MCOs), CMS, and other support organizations to fill in the gaps with additional funding and more informed resource allocation.
While the original intent was to address acute LOC needs in SUD, once built, this analysis could be reconfigured and repeated to measure other acute service needs, including prenatal care, diabetes, and cancer.
The underlying value was that policy makers and providers could now more proactively identify where there may be critical care gaps caused by lack of qualified providers within a specific geographic region.
By working with the MCOs, the leaders within the state’s Medicaid services could work to close those gaps and make it easier for its people to get the preventive and diagnosis care they need, reducing the long-term cost of care and improving the quality of life for people.
An example of the additional value that the state was able to generate was an analysis of impact of suitable and stable housing as a social determinant of health. In this analysis, the state could evaluate how often Medicaid subscribers move and how it affects their health and access to care.
With Alteryx, the state was able to undertake a significant piece of geospatial analysis to support a Section 1115 Waiver for SUD-related services, and as a result, could better inform policy decisions that would work to improve the level of care for those requiring Medicaid services across the state. While there is still work to be done to end the opioid crisis locally and across the county, the innovation and insight brought forth by this effort is having a direct benefit in helping people improve their health and quality of life.
How can everyone – from data scientists to activists – use data effectively in order to make a positive difference in human issues such as the opioid epidemic?
Check out this Alter Everything podcast featuring Dan Schneider from the Netflix docuseries, The Pharmacist, to learn how he’s used data to fight the opioid epidemic.