Analyzing pharmacy and medical data can inform employers about SUD diagnoses and their concurrent treatment patterns. Again, this data can be further stratified to be more informative.
How many members have been diagnosed with a substance use disorder?
Although likely an underestimate of how many health plan members are truly struggling with substance misuse or SUD, identifying how many individuals have been clinically diagnosed is an important step for employers to understand the breadth and severity of their workforce and dependents’ situation. For further insight, employers should request a breakdown of SUDs by type.
Measures to Request:
- Substance Use Disorder Diagnoses
- Alcohol Use Disorder Diagnoses
- Opioid Use Disorder Diagnoses
Are members with a substance use disorder getting treatment?
Not all health plan members who are diagnosed with a substance use disorder will access treatment. Employers should analyze how many diagnosed members receive treatment to understand any barriers to accessing treatment. For further insight, employers should look at a breakdown of the types and levels of treatment their members are accessing. Additionally, a look at what kind of treatment is being utilized can provide valuable insight into whether or not members are getting evidence-based treatment.
Measures to Request:
- Identification of Alcohol and Other Drug Services
- Use of Pharmacotherapy for Opioid Use Disorder
- Counseling on Psychosocial and Pharmacologic Treatment Options for Opioid Addiction
- Follow-Up After High-Intensity Care for Substance Use Disorder
It is clear that addiction treatment and recovery outcomes are highly individualized. Ideally, each individual will receive the right care, at the right place, at the right time for the optimal chance at a good outcome. What is not clear is how to adequately measure these outcomes. National standards are lacking. Addiction treatment programs have historically been siloed from other medical care, and models for recovery from SUDs do not exist as they do for other chronic diseases. Experts hold various opinions on what these outcomes look like and how they can be adequately measured. National and state leaders in healthcare quality measurement are working towards identifying these measures, and employers are well-suited to be influential in these discussions. This toolkit will be updated online as these measures are made available.