Healthcare Patterns Inside and Outside of Health Systems Among Medicare Beneficiaries With Substance Use Disorder

• In Event: Policies Affecting Medicare Beneficiaries

Abstract

Introduction/Background: Substance use disorder (SUD) is substantially undertreated in the US. Fragmentation of treatment into specialty programs disconnected from other medical settings is a key barrier to care. Health systems are growing rapidly, with formerly independent practices increasingly becoming part of these systems. Despite efforts to integrate SUD treatment, the degree to which people with SUD receive care from health system affiliated vs. non-affiliated providers is unknown.

Purpose/Research Question: This study characterized care patterns inside and outside health systems among people with SUD.

Data: This study included quantitative data from 2022 Medicare fee-for-service claims data linked to the Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S. Health Systems files.

Research Design and Methods: Using 2022 Medicare fee-for-service claims data linked to the AHRQ Compendium of U.S. Health Systems files, we identified patients with SUD and providers delivering their care. We used national provider identifiers to determine health system affiliation and describe patterns of SUD and other non-SUD medical care among people with SUD inside and outside systems.

Results/Findings: In 2022, 321,427 Medicare beneficiaries had SUD and received medical care from 770,506 providers, 58.7% of whom were affiliated with a health system. Overall, 75.6% of patients received care both inside and outside health systems, while 10.4% received all care within and 14.0% received all care outside systems. Patients receiving care both inside and outside systems had a higher volume of SUD services (mean: 3.44) compared to those only within (1.99) or outside systems (1.93). Ninety-one percent of patients also received other non-SUD medical care; the mean number of non-SUD services was 35.13 for those receiving care in both settings, 10.94 for those only within systems, and 9.24 for those only outside of health systems.

Conclusions/Implications: Most Medicare beneficiaries with SUD received care from both health system affiliated and non-affiliated providers. These patterns have implications for understanding both benefits and potential unintended consequences of care integration into health systems.

Author

• Kayla Nicole Tormohlen, Cornell University
  Presenting Author