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.