Evidence for Misspecification of a Nationally Used Quality Measure for Substance Use Treatment

Published in: The Journal for Healthcare Quality, Volume 40, Number 4 (July/August 2018), Pages 228-235

Posted on RAND.org on March 06, 2019

by Soeren Mattke, Zachary Predmore, Elizabeth M. Sloss, Asa Wilks, Katherine E. Watkins

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The National Committee for Quality Assurance's (NCQA) measure "Initiation and Engagement of Alcohol and Other Drug Dependence Treatment" captures the proportion of substance use patients with (1) treatment initiation within 14 days and (2) treatment engagement within 30 days thereafter. The definition of treatment considers only counseling but not medication-assisted treatment (MAT), although MAT is supported by current guidelines. Our research question is whether this omission results in meaningful measurement error.

Study Design And Methods

We analyze claims data for members of commercial health plans to investigate whether including MAT would meaningfully change the measure rate and health plan rankings.


Including MAT increased both the initiation and engagement rates. The initiation and engagement rates increased 2.4% (38.9-39.8%) and 9.9% (12.9-14%), respectively. These differences imply that 19% of health plans would change their ranking by at least one quintile for the initiation measure and 27% for the engagement measure.


The current specifications result in erroneous conclusions about the quality of care provided by different health plans. Our results suggest that aligning the measure specifications with guideline recommendations, as recently proposed by NCQA, would result in more accurate information.

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