NCQA Joins White House Listening Session on the Opioid Crisis?

On December 9, NCQA staff shared their expertise in quality measurement and behavioral healthcare at a White House listening session, “The Future of Quality Measurement for Opioid Use Disorder (OUD) Treatment,” co-hosted by the Office of National Drug Control Policy and the Domestic Policy Council .

NCQA representatives Eric Schneider , Executive Vice President, Quality Measurement and Research Group; Julie Seibert , Assistant Vice President, Behavioral Health; and Michael J.E. Grier, MPH , Director, Federal Affairs joined the conversation, along with experts from government, academia, health care nonprofits and associations.

“This event highlights the need for increased focus on ensuring effective delivery of treatments and medications for opioid use disorder,” says Schneider. “This gathering of experts at the White House pinpointed gaps in our current approach and enabled exchange of ideas on measurement approaches that prioritize the patient experience and can drive evidence-based treatment of OUD.”

Understanding the Opioid Overdose Epidemic

Opioids are a highly addictive class of drugs. In 2022, nearly 108,000 people in the U.S. died from drug overdose, and approximately 82,000 (76%) of those deaths involved opioids. While the rate of overdose deaths from heroin and other prescription opioids decreased from 2021–2022, deaths from illegally produced fentanyl, xylazine and other potent synthetic opioids increased.

“Opioid use disorder is a complex disease. There are medications that help, but not everyone seeks treatment,” says Seibert. “Some people are concerned about the stigma associated with addiction, and others simply lack access to treatment—either because they don’t have insurance or because there’s a shortage of providers in their community.”

How NCQA’s Work Contributes to Improving OUD Treatment

NCQA is taking steps to address the gaps in OUD treatment and quality measurement.

• We published a white paper, Improving Accountability for Behavioral Health Care Access, and are developing a HEDIS? measure for network adequacy.
• We developed seven HEDIS measures related to substance use disorders; four concentrate on opioid use:Use of Opioids at High Dosage (HDO)Use of Opioids from Multiple Providers (UOP)Risk of Continued Opioid Use (COU)Pharmacotherapy for Opioid Use Disorder (POD)
• We completed testing person-centered outcome measures for behavioral health, which could contribute to the cascade of care for responding to the opioid epidemic.
• We updated our credentialing standards to get practitioners enrolled into networks faster. Because most verifications are performed electronically, NCQA shortened the time for completing verification reviews.
• Our Patient-Centered Medical Home Recognition program is the most widely adopted primary care evaluation program in the country. Our Distinction in Behavioral Health Integration helps primary care practices integrate behavioral healthcare, and can support integrated care for people with OUD.

NCQA’s Key Takeaways from the Listening Session

Participants joined group discussions to assess the current state of OUD treatment and outcomes in the U.S., and to share their views on improving behavioral health workforce and access, quality measures, payment models and integrated care. The bottom line: There’s a lot of work to do, and not enough funding. Some key points raised included the following.

Behavioral Health Workforce and Access

• The widespread problem of an insufficient workforce limits access to treatment for people with OUD.
• We must expand the workforce to include community health workers, peer support, recovery coaches and other non-clinician roles.
• Quality measures should evaluate whether organizations have an adequate workforce in place.
• Organizations need to expedite credentialing so providers can start treating patients sooner and be appropriately compensated.

Quality Measurement

• OUD is a complex condition requiring multifaceted interventions and multiple measures to evaluate quality of care effectively.
• We need two types of quality measures: measures that focus on clinical information to help clinicians provide better care and measures that can inform payment models.
• Measures related to medications for OUD should look at adherence over time.
• There are too many process-oriented measures—we need more outcome measures and patient experience measures.

Payment Models

• Bundled rates can be effective in treating complex diseases such as OUD, but they can be an administrative burden for smaller organizations.
• Payment should address the co-morbidities associated with OUD, which ties into an integrated care approach between physical health and behavioral health.
• We need new measurement concepts that align with evidence-based treatment.

Integrated Care Delivery

• Integrated care provides a coordinated, supportive patient experience that centers on whole-person care.
• We can evaluate the success of integrated care for people with OUD by looking at changes in physical health in addition to medication adherence.
• Having a designated medical home allows ongoing management of OUD treatment and measurement of outcomes.

Looking Ahead

NCQA is optimistic about the future and the growing momentum behind the national movement for better OUD treatment quality and measurement.

“We are energized by the discussions at the event, and look forward to continued collaboration with federal and state policymakers, as well as with other stakeholders,” says Grier. “With the reauthorization of the 2018 SUPPORT Act, we can continue our efforts to improve quality and outcomes for people with OUD.”

HEDIS? is a registered trademark of the National Committee for Quality Assurance (NCQA).