HSR PhD Oral Defense of Dissertation Proposal - Demystifying Healthcare Reform Implementation Processes and Patient Service Patterns in Substance Use Disorder Treatment.

Title: Demystifying Healthcare Reform Implementation Processes and Patient Service Patterns in Substance Use Disorder Treatment

Description: Multiyear trends showing high rates of alcohol and opioid-related misuse as well as opioid-related deaths have renewed attention on both access to and the quality of SUD treatment. In response, diverse healthcare systems that care for the Medicaid population have begun implementing large-scale transformations including new services and provider SUD training requirements. The Centers for Medicaid and Medicare Services has urged state Medicaid programs to use 1115 waiver demonstrations as vehicles for SUD treatment delivery systems transformation. For many states, undertaking the 1115 waiver demonstration means moving from very limited benefits to a full continuum of new services. States’ ability to achieve such transformations is unknown since demonstration processes are under-reported and considered implementation “black boxes”. SUD delivery change is also occurring at the community level, where several hospitals systems have implemented new services to meet the needs of their SUD patient population. However, the influence of these new care models on patient service utilization is unknown.

In this dissertation, I will use qualitative content analysis methods to examine the pre-implementation decision-making process that states experience when deciding to enhance their SUD service delivery systems using 1115 waivers. A subsequent qualitative comparative case study of state Medicaid programs implementing SUD care continuums will describe common implementation strategies, challenges and facilitators associated with the current 1115 demonstration. Finally, I will use latent transition analysis to examine how the nature of services available to patients influences their service utilization over time. This final quantitative analysis will be set within the context of a safety net hospital that provides a comprehensive SUD service model to a largely Medicaid patient population. Results of this dissertation will illuminate processes and outcomes associated with pre-, mid-, and post-implementation activities targeting improvements in the delivery of SUD services.