Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment. APPENDIX C: Algorithm for Identifying Members with Alcohol or Other Substance Use Disorders

03/06/2019

TABLE C.1. Algorithm for Identifying Members with Alcohol or Other SUDs
Measure Component Algorithm
Numerator The number of beneficiaries with at least 1 of the following 3 criteria:
  • A medical claim (i.e., a non-radiological and a non-laboratory claim) with a diagnosis of alcohol or other drug use in any position. Please see Appendix B for diagnoses and diagnostic categories.
  • A prescription claim for buprenorphine/naloxone; XR-naltrexone; naltrexone; acomprosate; or disulfiram.
  • A prescription claim for oral sublingual buprenorphine. Injectable, transdermal, and oral buccal buprenorphine are not included because they are indicated for pain instead of SUDs.
Denominator Beneficiary-years is calculated by summing the months of enrollment for all beneficiaries and dividing by 12.