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


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.