Characteristics of accountable care organizations offering methadone to patients with opioid use disorder

Understanding whether organizations with Medicare and Medicaid accountable care organization (ACO) contracts offer methadone provides important context about how organizations invested in payment and delivery system reform address the needs of patients with substance use disorders. We used data from the 2021-2022 National Survey of Accountable Care Organizations to assess whether organizations with ACO contracts, which are held accountable for the cost and quality of care for an assigned patient population, offered methadone to patients with opioid use disorder (OUD), and the organizational and contextual characteristics associated with doing so. We found that 28.3% of survey respondents reported that clinicians in their organizations offered methadone via an opioid treatment program. In adjusted analyses, organizations with a Medicaid ACO contract but no Medicare contract were more likely to offer methadone (46.0%, <i>P</i> < 0.05) than organizations with a Medicare-only contract (19.6%) or a Medicare and Medicaid contract (30.3%). Despite incentives to prioritize population health, most ACO-affiliated organizations were not offering individuals with OUD the full range of recommended medications and should work to enhance treatment options for this patient population.