• The target trendline in the graph above represents an accepted national benchmark percentile for Medicaid programs across the country. The value graphed historically was the national 50th percentile for comparison purposes. In 2020 (for measurement year 2019) we modified the value shown to demonstrate a target based on our actual performance.  For this measure, the target is the 90th national percentile.
• The annual reported rate captures activity during the previous calendar year. 
• This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
  • Beneficiaries with Medicare or other medical insurance were not included.
  • In Vermont Medicaid, medication assisted treatment (MAT) is currently billed as one unit per month. The HEDIS IET specification looks for one service within 14 days of index event to count as initiation and two services within 34 days of initiation for engagement. The DVHA Data Unit adjusted the IET rate to account for the multiple visits each week occurring at the MAT opioid treatment programs.
  • VT billing codes for behavioral health residential treatment do not match the IET measure, but for this measure are counted as sub-acute facility visits.
• DVHA’s rates only include Medicaid Primary beneficiaries in HEDIS administrative measures.
• Due to significant changes that were made to the IET measure technical specifications for the HEDIS 2018 season, 2018 has been set as the new baseline measurement year for this measure. Historic data remains on the trend line above, but comparisons to baseline will not begin until after the HEDIS 2019 season's rates are available. Changes to the technical specifications include guidelines for incorporating telehealth and MAT services, as well as specifications for reporting out by substance type (alcohol, opioids and other substances).

This measure assesses the degree to which Vermont Medicaid initiates (starts) and engages (continues) treatment for members identified with a need for alcohol and other drug dependence (AOD) services. Two rates are reported for this measure:

• Initiation – the % of Medicaid beneficiaries diagnosed with AOD dependence who start treatment through an inpatient AOD admission, an outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth or medication treatment within 14 days of the diagnosis. (The data represented in the chart here is the DVHA's Initiation Total rate (13-17 years combined with 18+ years. Separate initiation rates for those population sub-sets are also tracked.)
• Engagement – the % of Medicaid beneficiaries diagnosed with AOD dependence who then received two (2) additional AOD services within 34 days after the start of AOD treatment. (See next chart in scorecard.)

The need for Vermont to work on our opioid use epidemic is well documented and has garnered media and public attention. Possibly less well known, is the fact that alcohol abuse, on its own, still represents the larger percentage of substance abuse for Vermonters. Please read further under “What Works” and “Action Plan” to learn more about what Vermont Medicaid is doing to help Vermonters prevent and treat substance abuse.

The treatment initiation rate remained steady during measurement year (MY) 2020, in spite of the pandemic. During that time the number of people seeking care for alcohol use decreased, but we saw increases in the number of people accessing care for opioids during the pandemic. The results of this measure are greatly impacted by the use of medication assisted therapy (MAT) and there were some changes in the federal regulations that gave more flexibility to providers and clients around MAT dosing and prescribing.

Last updated:  September 2021

• Vermont Medicaid beneficiaries and families
• Community Providers – such as Licensed Alcohol & Drug Counselors (LADCs), primary care physicians and mental health practitioners
• Hospitals
• Blueprint for Health
• OneCare Vermont
• Other Agency of Human Services Departments –
  • Vermont Department of Health’s Alcohol and Drug Abuse Programs (ADAP)
  • Department of Children and Families
  • Department of Mental Health
  • Department of Corrections

This link to the Vermont Department of Health website contains information about substance use treatment centers in Vermont, the Care Alliance for Opioid Addiction, medication assisted therapy (MAT), as well as other parent and community resources:  http://www.healthvermont.gov/a...

This measure and this topic, Initiation of Alcohol and Other Drug Dependence Treatment, has been a high priority for Vermont Medicaid for years. Between 2013-2015 we worked on a grant funded Quality Improvement Project with the goal of increasing our substance use disorder treatment rates. We focused on opening up the Medicaid provider network to Licensed Alcohol and Drug Counselors (LADCs). We also offered a payment reform approach, by providing enhanced payment for quality outcomes. These strategies did not significantly increase the overall treatment rates for Medicaid beneficiaries.

Although this is clearly a multi-faceted and difficult issue to impact, we chose substance use treatment as a topic for a more formal Performance Improvement Project (PIP), results of which were submitted to CMS from 2017 - 2020. Department of Vermont Health Access (DVHA) Quality Unit staff partnered with staff in the Health Department's Alcohol and Drug Abuse Programs (ADAP), the Blueprint for Health and OneCare Vermont to design a project meant to drive more Vermonters newly diagnosed with a substance use disorder to treatment. The project's largest intervention focus was the promotion of telemedicine appointments. To that end, activities included:

• • targeted communications to providers about telehealth dispersed via banners,
  • provider Advisory articles about telehealth, 
  • a telemedicine handout to be used during provider/association outreach visits,
  • presentations to local stakeholder groups,
  • the build out of a section on the DVHA website to hold these telemedicine resources and additional links,
  • partnering with the Vermont Program for Quality in Health Care (VPQHC) to create a multi-payer, state-wide telehealth task force.