Increasing Access to Opioid Use Disorder Treatment: Assessing State Policies and the Evidence Behind Them.

OBJECTIVE: Combatting the opioid epidemic requires systemic policy changes that address the underutilization of medication-assisted treatment, a therapy that is effective in treating opioid use disorder. In this study, we present approaches used in five states to increase medication-assisted treatment financing and access. METHOD: We conducted case studies in five U.S. states, interviewing key informants and reviewing the published literature and unpublished documents. RESULTS: In these states, Medicaid expansion was the most significant lever available to expand financing and access to medication-assisted treatment. Other key levers include Medicaid Section 1115 SUD demonstrations, State Targeted Response to the Opioid Crisis and State Opioid Response grants, state contracting mechanisms, and other state regulations. CONCLUSIONS: States in this study reported substantial progress in increasing access to medication-assisted treatment, but empirical evidence of their effects is still emerging.

Bed Tracking Systems: Do They Help Address Challenges in Finding Available Inpatient Beds?

OBJECTIVE: Locating open beds in hospital and residential mental health and substance use disorder treatment settings has been an ongoing challenge in the United States. The inability to find open beds has contributed to long emergency department wait times and missed opportunities to engage patients in treatment. Increasingly, states are creating online bed tracking systems to improve access to timely information about bed availability. This study aimed to document how states are implementing bed tracking systems, their successes and challenges, and lessons learned. METHODS: A review was conducted of the published and gray literature available between 2008 and 2018, and 13 interviews were conducted with 18 stakeholders in five states (Connecticut, Iowa, Kansas, Massachusetts, and Virginia). RESULTS: The authors identified 17 states with bed tracking systems, of which five make information available to consumers. Most interviewees reported that the bed tracking systems were improving the ability of providers and consumers to more readily locate openings. Challenges identified included that some hospitals will not participate in bed registries, data on bed availability is sometimes not timely enough, bed registries do not provide enough detail on whether the facility is capable of meeting a particular patient's needs, providers have not been coached to use the bed registry system and continue existing practices, and states that provide information to the public have not publicized the registry's existence. CONCLUSIONS: Bed tracking systems offer promise, but more needs to be done to understand how to realize their potential and to more widely implement lessons learned.