Project Summary To address opioid misuse and related morbidity and mortality, Oregon has initiated a novel statewide effort to use Medicaid benefit design to promote safer opioid prescribing practices around back pain. Under the new policy, Oregon Medicaid will sharply curb coverage of opioid medications for acute back pain and require physicians to develop a plan with patients on chronic opioid therapy for back pain to taper off this therapy by early 2018. Concurrently, Oregon Medicaid has expanded coverage of nonpharmacologic health services for back pain, including acupuncture, chiropractic manipulation, cognitive behavioral therapy, physical and occupational therapy, yoga, massage and supervised exercise therapy. This policy is the first of its kind in the country, and if successful, could serve as a model for other states in minimizing the potential harms of long-term opioid therapies while providing other evidence-based options to relieve pain. We will examine the clinical and economic effects of the policy, using Utah Medicaid enrollees with back pain and Oregon and Utah Medicaid enrollees without back pain as comparison groups, allowing us to isolate the effect of the policy. The study has three specific aims: First, we will evaluate the impact of the OBPP on opioid and non-opioid prescribing and use of non-pharmacologic therapies. Second, we will evaluate the impact of the policy on a) opioid-related clinical outcomes (e.g., overdose) or development of opioid use disorders b) back pain related clinical outcomes, as indicated by advanced imaging and/or need for surgery and c) overall healthcare service utilization and total health care spending for back-pain or opioid-related health care visits, prescription drugs, and non-pharmacologic services. Finally, we will conduct stakeholder interviews and focus groups with administrators and clinicians to characterize implementation approaches, barriers, and perceived effectiveness of the policy. Study findings will inform policymakers, health administrators, and practitioners nationwide on the effectiveness of large-scale implementation of benefit design policy to increase use of evidence-based practices and reduce opioid-related harms.

PROJECT NARRATIVE Oregon recently introduced a novel Medicaid policy for patients with back pain, increasing restrictions on the use of opioids for acute or chronic back pain, including a directive to taper patients on chronic opioid therapy completely off them by early 2018. At the same time, the policy expands coverage of non-pharmacologic therapies. The current proposal examines the adoption, health outcomes, health services utilization, and costs of the policy, and includes mixed methods study of the policy's implementation across the state.