To Test a Payer/Treatment Agency Intervention to Increase Use of Buprenorphine

A team of researchers from the University of Wisconsin-Madison College of Engineering and
Oregon Health & Science University will test whether clinician training and the use of
organizational change strategies are sufficient for disseminating an evidence-based practice
(EBP), or if changes to both organizational systems and payer policy results in greater EBP
use. Demonstrating the role of payment policy as a driver in the adoption of evidence-based
practices could provide a contribution to dissemination and implementation science. This
study will employ an intervention that was developed through the Robert Wood Johnson
Foundation-funded Advancing Recovery (AR) program. In AR, payer/treatment organization
partnerships in 12 states collaborated to remove systemic barriers to the adoption of EBPs
such as medication-assisted treatment for substance abuse disorders. The resulting "AR
Framework" of payer and organizational change strategies will be tested against its ability
to increase the use of the addiction medication buprenorphine as compared to organizational
change strategies alone. Buprenorphine is an EBP for treating people addicted to heroin or
opioid-based pain medications for non-medical use. Buprenorphine has experienced low adoption
rates and is not a standard part of addiction treatment. In Ohio, the location of the study,
deaths to due to accidental overdoses of opioids has increased by 304% over the past decade
and surpassed auto accidents as the leading cause of accidental deaths in 2006. Ohio was
selected for the study because of the public health significance of opioid abuse and because
each county in Ohio acts as a stand-alone payer, offering 48 unique eligible payer
environments. This trial will develop a deeper understanding of the role payers and treatment
organizations play in implementing and disseminating EBPs and will focus on the public health
issue of rising opioid abuse.