Substance use disorder (SUD) due to drugs other than alcohol is a leading cause of morbidity and mortality in the U.S., affecting nine percent of people aged 18 and older. However, few individuals receive effective treatment. Many people face significant personal and informational barriers to care, whether they are unable to navigate the health care system, lack the confidence to seek help, or lack the health literacy needed to understand their treatment options.
In recent years, 41 state Medicaid programs have adopted policies covering peer support services (PSS), which may help individuals with SUD overcome some of their personal, informational, or other barriers to accessing necessary treatment. PSS are non-clinical services encompassing a range of activities, such as recovery planning, helping individuals understand their treatment options, linking individuals with social services, and providing emotional support via trained and credentialed peers who have personally experienced SUD.
Dr. Jiani Yu, assistant professor of population health sciences, and Dr. Beth McGinty, chief of the Division of Health Policy and Economics, co-director of the Cornell Health Policy Center, and Livingston Farrand Professor of Population Health Sciences, have received an R01 from the National Institute on Drug Abuse to evaluate the impact of in-person and telehealth-delivered PSS on SUD-related outcomes among Medicaid beneficiaries.
Currently, little is known about whether PSS improve SUD treatment initiation and engagement, and how they impact adverse outcomes associated with SUD. “[The study] is particularly timely because many state Medicaid programs are now covering both PSS and telehealth services, and many of the activities associated with peer support can be done remotely,” said Dr. Yu. “We’re interested in the extent to which PSS aids people in their recovery process. The telehealth component may expand the number of people who can gain access to peer support.”
Existing research on the adoption of Medicaid-covered PSS is limited and has not examined the role of PSS in SUD treatment or its effect on adverse outcomes. As such, researchers will assess the relationship between PSS use and SUD treatment initiation, engagement, and retention, as well as SUD-related emergency department visits, unplanned SUD inpatient readmissions, and nonfatal and fatal overdoses. They will further assess PSS overall and compare in-person to telehealth services. Assessments will utilize a national sample of 2017 to 2024 Medicaid claims data.
Researchers will then interview policy and implementation leaders, including state Medicaid leaders and individuals from PSS organizations, to examine how Medicaid policy design influences PSS implementation and impact. Planned as a true mixed-methods study, the quantitative and qualitative findings will inform each other at different stages of the project.
“Study findings will provide new evidence on whether and how PSS can help people with SUD engage in treatment and prevent overdose, and whether there are specific scenarios—for example, following treatment for a nonfatal drug overdose—in which PSS are most helpful,” said Dr. McGinty.
“If we’re able to find evidence here in the Medicaid population that coverage of these services actually moves the needle in improving SUD coverage and engagement, then these findings could inform policy design,” said Dr. Yu. “This is important, given that Medicare and some commercial payers have just begun to cover PSS.”
Dr. Yu and Dr. McGinty will work alongside Dr. Yuhua Bao, professor of population health sciences; Dr. Kayla Tormohlen, senior research associate in population health sciences; Dr. Elizabeth Stuart, Frank Hurley and Catharine Dorrier Chair of the Department of Biostatistics and Bloomberg Professor of American Health at the Johns Hopkins Bloomberg School of Public Health; and Dr. Michael Fingerhood, professor of medicine and public health at Johns Hopkins University.
The study’s findings are expected to inform the rapidly evolving adoption of PSS insurance coverage policies and improve the implementation of evidence-based strategies in real-world settings. “It’s critical that we understand how the health care delivery system can support nonclinical ways to engage individuals more effectively with SUD treatment and recovery services,” said Dr. Yu.
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