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TEAMKY Demonstration

Approval Period: January 1, 2025 through December 31, 2029

Page 115 of 155 KTOS and KORTOS are two ongoing studies conducted by the University of Kentucky Center on Drug and Alcohol Research in collaboration with the Kentucky Department of Behavioral Health, Developmental, and Intellectual Disabilities. KTOS is a study of patients enrolling in SUD treatment programs (including outpatient, residential, and inpatient programs), and KORTOS is a study of patients enrolling in opiate treatment programs. KTOS enrolls about 1200 patients annually (of whom 950 are Medicaid-insured) who complete surveys at intake and at 12 months; KORTOS enrolls about 240 patients annually (of whom 150 are Medicaid-insured) who complete surveys at intake and at 6 months. We will use self-reported measures of physical health, mental health, and substance use from KTOS and KORTOS to evaluate the effect of the demonstration on improvements in beneficiary health and care.

The major limitations of these surveys are the voluntary participation in the surveys, the 35%-40% attrition rates for Medicaid-insured respondents, and the relatively small sample sizes, all of which may lead to selection bias and limit the scope of inferences. Because of these limitations, evaluation of these measures should be viewed with particular caution. Nevertheless, KTOS and KORTOS provide important measures of health and substance use of the demonstration's target population that are not easily obtainable elsewhere.

We have been informed that, because of funding difficulties, there is a possibility that these surveys could be discontinued during the demonstration period. If this is the case, or if KTOS and KORTOS are not able to provide sufficient information for the proposed evaluation of patient outcomes, the Penn team will re-evaluate and may propose conducting a separate beneficiary survey. As well, if the available information on provider enrollment is insufficient to meet the stated goals of the evaluation, the Penn team may propose conducting a novel provider survey.

C.4.5. Qualitative beneficiary survey As part of the evaluation of the larger non-SUD 1115 demonstration, the University of Pennsylvania fielded a survey of Medicaid beneficiaries in 2018. For the qualitative SUD beneficiary survey, respondents from the general demonstration survey who meet SUD criteria will be contacted for qualitative interviews on substance use, enrollment in SUD treatment, and experience with SUD providers.

C.5. Analytic Methods A mixed methods approach will be used in the evaluation of the SUD demonstration. Quantitative analyses will be used to assess the impact of the demonstration, while qualitative analyses will be used to provide detail and depth to beneficiary experience of provider and treatment aspects of the demonstration.

C.5.1. Quantitative analyses The purpose of these analyses is to quantitatively describe and statistically evaluate the effect of the demonstration. Although a quasi-experimental design would have been ideal, the comprehensive statewide implementation of the demonstration means that internal comparisons are not feasible. As stated above, we investigated the possibility of an external comparison group but were unable to identify states with similar demographic and institutional characteristics that were not also implementing comparable SUD programs, namely the waiver of the IMD exclusion