Last Updated: Aug 2022. 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.
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
Rapid Treatment Access (RTA) refines Vermont's treatment system for alcohol use disorder (AUD) by:
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.