Identifying Opioid Treatment Programs in Medicaid claims data to support quality improvement

In the United States, opioid treatment programs (OTPS) are the only provider type licensed to dispense methadone. Recently, U.S. regulators revised OTPs regulations with the aim of making OTP treatment more patient-centered and improving retention in treatment. Creating OTPs retention measures across all OTPs in the U.S. would give OTPs an important window into their retention rates relative to benchmarks and help identify which policies and procedures are most effective in improving retention. In the United States, insurance claims data are one of the few data sources available to create these metrics. Claims data include national provider identifiers; however, the Federal agency that regulates OTPs does not make public which national provider identifiers are associated with OTPs. This study investigated whether other variables captured in Medicaid claims could be used to identify OTPs. We identified two variables: methadone dispensing procedure codes and methadone clinic taxonomy codes, which identified 80 % and 66.8 % of the count of Medicaid-participating OTPs.Place of service and bill type codes were recently added to claims data and may be useful in the future. Methadone can reduce overdose deaths by 50 % but only if patients are maintained on methadone long enough. OTP metrics created with insurance claims data would facilitate efforts to improve retention and outcomes. This study identifies a practical way to identify OTPs in claims data to support such measures in the absence of a Federal list of OTPs and their national provider identifiers.