Last Updated: September 2024. Author: Division of Substance Use Programs, Vermont Department of Health

Note:  Some providers had delays in billing services which may have negatively impacted Initiation rates for 2021. 

People may be identified as potentially needing substance abuse treatment in many different places such as primary care practices substance use disorder treatment providers, hospitals, emergency departments, and mental health practitioners.

The wide variety of places where substance use disorders are identified highlight the importance of coordinating care for those who may need help.

When an individual is identified by a provider as needing treatment for a substance use disorder (addiction), it can be difficult to get the individual to seek treatment. This may be due to a variety of perceived roadblocks such as the time it takes to access treatment, lack of transportation, inability to find childcare, etc. The most frequently cited reason for individuals not initiating treatment is the belief of the lack of a problem so treatment is perceived as unnecessary. Like other chronic diseases such as diabetes or heart disease, the sooner an individual seeks treatment, the more likely the person is to recover. Individuals with substance use disorders need to know where to get help (access), initiate treatment, and stay in treatment for long enough to recover (engagement). Providers can help by offering screening in their offices and talking with patients about substance use.

Programs have been struggling to recruit and retain workforce during and after the COVID-19 emergency which may be impacting the initiation and engagement rates.

For 2022, there were significant changes in the definition of the measure that is used to calculate these values.  The methodology change can't be differentiated from programming.

• Primary Care Practices
• Hospital emergency departments and inpatient programs
• Medicaid beneficiaries and families
• Community Providers – such as Licensed Alcohol & Drug Counselors (LADCs) and mental health practitioners
• Division of Substance Use Preferred Providers
• Recovery Centers
• AHS Departments (Department of Vermont Health Access, Vermont Department of Health Division of Substance Use Programs, Department Children and Family, Department of Corrections, Department of Disability, Aging and Independent Living, Department of Mental Health)

The following list highlights some of the strategies and best practices to improve initiation and engagement of alcohol and other drug treatment in clinical and community settings

• Strengthen the substance use disorder referral and evaluation systems at the community-level
• Increase the capacity to treat all substance use disorders in the community
• Continue expansion of the Rapid Access to Medication Assisted Treatment (RAM) and Rapid Treatment Access (RTA) initiatives statewide
• Strengthen partnerships between healthcare and recovery support services, such as the Recovery Coaches in Emergency Departments initiative
• Build relationships to improve communication and collaboration around referrals
• Strengthen peer support services and build connections for individuals to access those services
• Development of workforce with training in alcohol and drug misue through partnerships with local colleges and universities
• Establish policies and procedures to assess and treat all clients at risk for or experiencing a substance use disorder that incorporate principles of harm reduction and the social determinants of health
• Establish and integrate principles of harm reduction and the social determinants of health into all new and existing programs that address substance use across the system (e.g., syringe services programs, naloxone overdose prevention programs)

The Vermont Department of Health, Division of Substance Use Programs (DSU) started the Rapid Treatment Access (RTA) project to respond to individuals seeking treatment and supports for alcohol use disorder (AUD). RTA builds upon the Rapid Access to Medication Assisted Treatment (RAM) for Opioid Use Disorder (OUD) model that was implemented statewide to respond to individuals with OUD. RTA is in the process of being rolled out statewide.

Rapid Treatment Access (RTA) refines Vermont's treatment system for alcohol use disorder (AUD) by:

• Smoothing the pathways for individuals to access treatment.
• Reinforcing evidence-based best practice.
• Recognizing that hospital emergency departments (EDs) may serve as a critical access point for individuals in rural communities and by integrating the ED into the system of care.
• Raising awareness of community-based treatment/recovery services.
• Supporting providers in the application of continuous quality/rapid cycle process improvement tools and techniques.

These rates are based on the Healthcare Effectiveness Data and Information Set (HEDIS) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) access to care measure. Substance induced mental disorders were not included. The rates exclude beneficiaries with Medicare or other medical insurance due to incomplete Medicaid claims history.

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 30 days of initiation for engagement. An adjustment to the IET rate was used to count the multiple visits each week occurring at the MAT opioid treatment programs. Also, 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.

Initiation is the % of Medicaid beneficiaries diagnosed with alcohol and other drug (AOD) dependence who start treatment through an inpatient AOD admission or an outpatient service for AOD abuse or dependence within 14 days.

Please note that treatment services are offered through Community Health Teams and Spoke Staff that may not be reflected in these numbers because the funding mechanism for these teams does not require the generation of a service claim. Since the measure is based on Medicaid claims data, the numbers likely under-represent the rates of initiation and engagement in treatment.

For 2022, the HEDIS code for the measure changed in these ways, resulting :

• We are now looking for SUD episodes as early as Nov. 15^th of the year prior to the measurement year, instead of Jan. 1^st of the measurement year.
• The negative diagnosis/medication history requirement for the denominator has been extended from 60 days to 194 days.
• The continuous enrollment requirement for the denominator has been extended from 108 days to 242 days.