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Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment

BACKGROUND: Despite the important upstream impact policy has on population health outcomes, few studies in implementation science in health have examined implementation processes and strategies used to translate state and federal policies into accessible services in the community. This study examine...

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Autores principales: Crable, Erika L., Benintendi, Allyn, Jones, David K., Walley, Alexander Y., Hicks, Jacqueline Milton, Drainoni, Mari-Lynn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734202/
https://www.ncbi.nlm.nih.gov/pubmed/34991638
http://dx.doi.org/10.1186/s13012-021-01182-4
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author Crable, Erika L.
Benintendi, Allyn
Jones, David K.
Walley, Alexander Y.
Hicks, Jacqueline Milton
Drainoni, Mari-Lynn
author_facet Crable, Erika L.
Benintendi, Allyn
Jones, David K.
Walley, Alexander Y.
Hicks, Jacqueline Milton
Drainoni, Mari-Lynn
author_sort Crable, Erika L.
collection PubMed
description BACKGROUND: Despite the important upstream impact policy has on population health outcomes, few studies in implementation science in health have examined implementation processes and strategies used to translate state and federal policies into accessible services in the community. This study examines the policy implementation strategies and experiences of Medicaid programs in three US states that responded to a federal prompt to improve access to evidence-based practice (EBP) substance use disorder (SUD) treatment. METHODS: Three US state Medicaid programs implementing American Society of Addiction Medicine (ASAM) Criteria-driven SUD services under Section 1115 waiver authority were used as cases. We conducted 44 semi-structured interviews with Medicaid staff, providers and health systems partners in California, Virginia, and West Virginia. Interviews were triangulated with document review of state readiness and implementation plans. The Exploration, Preparation, Implementation, Sustainment Framework (EPIS) guided qualitative theme analysis. The Expert Recommendations for Implementing Change and Specify It criteria were used to create a taxonomy of policy implementation strategies used by policymakers to promote providers’ uptake of statewide EBP SUD care continuums. RESULTS: Four themes describe states’ experiences and outcomes implementing a complex EBP SUD treatment policy directive: (1) Medicaid agencies adapted their inner/outer contexts to align with EBPs and adapted EBPs to fit their local context; (2) enhanced financial reimbursement arrangements were inadequate bridging factors to achieve statewide adoption of new SUD services; (3) despite trainings, service providers and managed care organizations demonstrated poor fidelity to the ASAM Criteria; and (4) successful policy adoption at the state level did not guarantee service providers’ uptake of EBPs. States used 29 implementation strategies to implement EBP SUD care continuums. Implementation strategies were used in the Exploration (n=6), Preparation (n=10), Implementation (n=19), and Sustainment (n=6) phases, and primarily focused on developing stakeholder interrelationships, evaluative and iterative approaches, and financing. CONCLUSIONS: This study enhances our understanding of statewide policy implementation outcomes in low-resource, public healthcare settings. Themes highlight the need for additional pre-implementation and sustainment focused implementation strategies. The taxonomy of detailed policy implementation strategies employed by policymakers across states should be tested in future policy implementation research. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-021-01182-4.
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spelling pubmed-87342022022-01-07 Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment Crable, Erika L. Benintendi, Allyn Jones, David K. Walley, Alexander Y. Hicks, Jacqueline Milton Drainoni, Mari-Lynn Implement Sci Research BACKGROUND: Despite the important upstream impact policy has on population health outcomes, few studies in implementation science in health have examined implementation processes and strategies used to translate state and federal policies into accessible services in the community. This study examines the policy implementation strategies and experiences of Medicaid programs in three US states that responded to a federal prompt to improve access to evidence-based practice (EBP) substance use disorder (SUD) treatment. METHODS: Three US state Medicaid programs implementing American Society of Addiction Medicine (ASAM) Criteria-driven SUD services under Section 1115 waiver authority were used as cases. We conducted 44 semi-structured interviews with Medicaid staff, providers and health systems partners in California, Virginia, and West Virginia. Interviews were triangulated with document review of state readiness and implementation plans. The Exploration, Preparation, Implementation, Sustainment Framework (EPIS) guided qualitative theme analysis. The Expert Recommendations for Implementing Change and Specify It criteria were used to create a taxonomy of policy implementation strategies used by policymakers to promote providers’ uptake of statewide EBP SUD care continuums. RESULTS: Four themes describe states’ experiences and outcomes implementing a complex EBP SUD treatment policy directive: (1) Medicaid agencies adapted their inner/outer contexts to align with EBPs and adapted EBPs to fit their local context; (2) enhanced financial reimbursement arrangements were inadequate bridging factors to achieve statewide adoption of new SUD services; (3) despite trainings, service providers and managed care organizations demonstrated poor fidelity to the ASAM Criteria; and (4) successful policy adoption at the state level did not guarantee service providers’ uptake of EBPs. States used 29 implementation strategies to implement EBP SUD care continuums. Implementation strategies were used in the Exploration (n=6), Preparation (n=10), Implementation (n=19), and Sustainment (n=6) phases, and primarily focused on developing stakeholder interrelationships, evaluative and iterative approaches, and financing. CONCLUSIONS: This study enhances our understanding of statewide policy implementation outcomes in low-resource, public healthcare settings. Themes highlight the need for additional pre-implementation and sustainment focused implementation strategies. The taxonomy of detailed policy implementation strategies employed by policymakers across states should be tested in future policy implementation research. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-021-01182-4. BioMed Central 2022-01-06 /pmc/articles/PMC8734202/ /pubmed/34991638 http://dx.doi.org/10.1186/s13012-021-01182-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Crable, Erika L.
Benintendi, Allyn
Jones, David K.
Walley, Alexander Y.
Hicks, Jacqueline Milton
Drainoni, Mari-Lynn
Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment
title Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment
title_full Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment
title_fullStr Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment
title_full_unstemmed Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment
title_short Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment
title_sort translating medicaid policy into practice: policy implementation strategies from three us states’ experiences enhancing substance use disorder treatment
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734202/
https://www.ncbi.nlm.nih.gov/pubmed/34991638
http://dx.doi.org/10.1186/s13012-021-01182-4
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