Substance Use Treatment
Medications for Opioid Use Disorder
The section below reports on individuals who received at least one form of medication indicative of Opioid Use Disorder (OUD) treatment. Medication for Opioid Use Disorder (MOUD) includes methadone maintenance (daily administration or take-home dosage), buprenorphine prescriptions, and naltrexone prescriptions. Prescription claims are provided by Physical Health Managed Care Organizations (PHMCO)- not Community Behavioral Health (CBH), a division of Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). Prescription data prior to 2017 is unavailable for analysis as data quality prior to 2017 was not reliable.
Number of Medicaid Beneficiaries Receiving Any Medication for Opioid Use Disorder (MOUD)
Key Findings: The number of individuals who received some form of medication used for Opioid Use Disorder treatment continuously increased between 2017 and 2019. In 2020, there was a 3% decrease in the number of individuals who received MOUD from 2019. In 2021, there were 17,496 individuals receiving some form of medication for Opioid Use Disorder treatment, a 4% increase from the prior year. Of those individuals, 5,399 received methadone, 11,533 received buprenorphine, and 564 received naltrexone as their most recent medication type. The number of individuals receiving buprenorphine increased by 8% from 2020 to 2021.
Substance Use Services
The following section features service utilization data of Medicaid beneficiaries in Philadelphia diagnosed in the behavioral health service system as well as medication use data of Medicaid beneficiaries. The treatment data is provided by CBH.
Under the HealthChoices program, CBH manages mental health and substance use treatment services for Medicaid-eligible individuals in Philadelphia. CBH’s administrative billing data for services from January 1, 2017 through December 31, 2020 are presented. Data for 2020 should be interpreted with caution as 2020 was not a typical treatment year due to 1) fewer claims being submitted as a result of the alternate payment arrangement (APA) 2) Medicaid beneficiaries not utilizing services due to the COVID-19 stay-at-home order 3) Medicaid beneficiaries experiencing trouble accessing services and 4) providers’ staff potentially being impacted by COVID-19 thus increasing wait times and clinician availability.
Behavioral Health Services
Behavioral health services include any mental health or substance use disorder (SUD) treatment services. This includes but is not limited to Medications for Opioid Use Disorder (MOUD), outpatient, intensive outpatient, partial hospitalization, case management, halfway house, residential rehabilitation, and detoxification.
Number of Medicaid Beneficiaries with a Primary Diagnosis of SUD Participating in any Behavioral Health Service
Key Findings: In 2017, there were 32,562 unique Medicaid beneficiaries with a primary diagnosis of SUD that participated in any behavioral health service. Since 2017, the number of unique Medicaid beneficiaries with a primary diagnosis of SUD participating in any behavioral health treatment has continued to decrease each year. In 2021, there were 23,343 unique members with primary diagnosis of SUD participating in behavioral health services with a rate of approximately 30 distinct individuals per 1,000 Medicaid beneficiaries.
Residential Rehabilitation
Residential rehabilitation services include hospital and non-hospital based, short- and long-term residential rehabilitation and specialty programs such as Journey of Hope and Women with Children. Service includes 24-hour professionally directed evaluation, care, and treatment for individuals with substance use disorder in acute or chronic distress. Residential rehabilitation claims were identified using level of care codes 150.002, 200.002, 200.007, 200.008, 200.009 200.010, 200.011, 200.012, 200.023.
Number of Medicaid Beneficiaries with a Primary Diagnosis of SUD Participating in Residential Rehabilitation Services
Key Findings: Between 2017 and 2019, the number of unique individuals with a primary diagnosis of SUD participating in residential rehabilitation increased 21% to 7,734 unique beneficiaries participating in residential rehabilitation services. In response to the opioid epidemic, CBH prioritized access to treatment by removing prior authorizations to residential rehabilitation allowing more members to access the service. In 2021, 6,552 unique Medicaid beneficiaries participated in residential rehabilitation programs.
Outpatient Services
Outpatient services are non-residential treatment services providing structured psychotherapy. Services can include assessments for evaluations using the American Society for Addiction Medicine (ASAM) or Pennsylvania Client Placement Criteria (PCPC), testing by a psychologist, therapy with a counselor, psychologist, or psychiatrist; individual, group, couple, or family therapy; medication administration, evaluation, or management; case management, peer support, co-occurring partial hospitalization, and collateral services. For outpatient services, regularly scheduled treatment sessions occur at least three days per week for at most five hours per week. Outpatient service claims were identified using level of care codes 350. – 351., 375.014, and 800.038.
Number of Medicaid Beneficiaries with a Primary Diagnosis of SUD Participating in Outpatient Services
Key Findings: Between 2017 and 2019, there were an average of 19,116 unique Medicaid beneficiaries who participated in outpatient services. In 2020, the number of unique Medicaid beneficiaries participating in outpatient services decreased 20% from 2019. In 2021, the number of unique Medicaid beneficiaries with a primary diagnosis SUD participating in outpatient services continued to decrease to 14,739 unique individuals.