October 19, 2023

We wanted to share a recent Office of the Inspector General (OIG) report looking at medication treatment rates for Opioid Use Disorder in Medicaid.  In NY, the percentage of Medicaid enrollees with OUD who received medication treatment (referred to as MOUD here) in 2021 was less than 50%. 

Office of the Inspector General Report: Many Medicaid Enrollees with Opioid Use Disorder Were Treated with Medication; However, Disparities Present Concerns (hhs.gov)  One-third of the 1.5 million Medicaid enrollees with opioid use disorder did not receive medication treatment (referred to as MOUD) in 2021. Certain demographic groups—including Black or African American enrollees; enrollees 18 years of age and younger; and enrollees with a disability and/or blindness—were less likely to receive MOUD. In 10 States, less than half of enrollees with opioid use disorder received MOUD. Download an infographic of this information
———————————

Here’s an interesting (and dare I say hopeful) article from Crain’s Health Pulse (10/19) featuring an interview with Paul Francis (held several NYS leadership roles in several administrations to include NYS Director of Budget and Deputy Secretary for Health and Human Services under former Governor Cuomo) who has launched a new think tank that aims to improve access to health data in New York.  Based on the interview (see highlighted content) it may be that NYS is considering investing in the development of a data system similar to the one in Massachusetts (described below).  

(Crain’s HP)
FORMER STATE HEALTH OFFICIAL ON HOW NY ‘FLIES BLIND’ WHEN IT COMES TO HEALTH DATA
Health data in New York lives across a range of state agencies. Hospital cost data, insurance claims, primary care and behavioral health utilization are reported separately, to various agencies including the Department of Health, the Department of Financial Services and the Office of Mental Health, to name a few.
The decentralized nature of health data in New York creates challenges for health care policymaking, said Paul Francis, who previously worked as deputy secretary of health and human services under Gov. Andrew Cuomo and senior adviser to the Department of Health.

After leaving his government job last May, Francis recently launched the Step Two Policy Project, a think tank that aims to improve access to health data in New York. He spoke to Crain’s about the challenges that poor data infrastructure has on policy, as well as models for success.

Why did you launch the Step Two Policy Project?

There are many good ideas that don’t get done in government for a variety of reasons. One is that when you’re in government, you need to be responsive to the crisis of the day. Addressing longer-term challenges, like data, it’s often a luxury that policymakers just don’t have—time to really do the hard thinking about what would be a good health data and information infrastructure.

How did New York’s health data infrastructure affect your work as a government official?

New York manages a $300 billion dollar health care ecosystem, but we fly that airplane blind with very few instruments. And that’s if you’re inside of government—when you’re inside of government and you can get data put together for you, curated for you, it’s still hard to get the data. It’s extraordinarily opaque from the outside. If you want to understand information about what insurance plans are doing in New York, you have to try to get it from DFS. If it is publicly available from DFS, it is very difficult to access. I used to have things put together for me, because I couldn’t find them publicly.

How do you create policies to address health issues that are difficult to quantify through public data?

That’s the magic word—you have to start with quantification of the problem. I was talking to somebody the other day about medical debt. And there’s a general feeling about medical debt that it’s a problem. It’s a problem that’s a paradox because the hospitals collect very little from medical debtors. It creates tremendous disruption in the lives of people. But when you try to find out exactly how many claims there are, what types of providers those claims are coming from, how many of those claims relate to copays and balance billing—the data isn’t there. You have to start with a strong evidence and fact base to be able to craft appropriate policies that will actually work.

How should New York address its health data infrastructure?

The light went on for me when I looked in more depth at how much health information is readily available and user-friendly in Massachusetts. It cuts across all these different silos. In New York, the insurance plans report information to DFS, except for the Medicaid plans, which report to DOH, mental health reports to OMH, etc. We have all these different silos that barely share information with each other, and there’s no central entity to synthesize that data.

Massachusetts created this single entity called CHIA in 2012, which by statute is the place where providers, insurance plans and others report information. I used the Picasso expression: good artists borrow, great artists steal. We don’t need to reinvent this wheel.

Do you think there is an interest among state officials to create an entity like this?

The short answer is yes. I think it’s a question of degree and emphasis, and that process will play out over the next three months for the executive and the next six months for the legislature. When you talk about the idea at a conceptual level, people think ‘of course, who wouldn’t want to have better health data.’ But it takes a push, and that’s sort of the idea of having a group like Step Two that hopefully can keep it on the radar.

How much of an impact do you think this could have on health policy in New York?

I think it’s common sense, that if you have transparency, you’re going to make better decisions than if you’re basing it on anecdotal information.

Interview by Amanda D’Ambrosio