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Data-driven decision making for opioid settlements

By: Sam Repka, Kristen Ukeomah, Frank McStay, & Rob Saunders

With unprecedented funding flowing to state and local decision-makers charged with developing opioid settlement spending plans, distribution of opioid litigation funding represents a unique opportunity for communities to design and sustain locally-driven treatment and recovery infrastructure. These decision-makers often have limited data-driven insights into the current needs of their communities, as well as their capacity to respond to these needs.

The Duke-Margolis Center for Health Policy, along with Third Horizon Strategies, launched a project funded by Elevance Health Foundation, to develop resources to guide state, county, and municipal investments of opioid settlement resources for their communities. The first resource in this project, the Opioid Abatement Needs and Investment Tool (OANI), is an interactive database that allows users to assess factors related to opioid dependency and a region’s ability to respond to the opioid crisis across five social determinant of health domains based on Healthy People 2030 (economic stability, education, healthcare, environment, and social). Based on these data, the tool generates a tailored resource guide to address identified needs and help inform policymakers and advocates participating in priority setting conversations for opioid settlement funds.

How Can This Tool Be Useful?

Needs Assessment: Many policymakers may not have sufficient data access or in-house expertise to identify local needs and opportunities to address the epidemic through opioid settlement funds. With this in mind, policymakers can use the Explore tab of the OANI tool to view their county or state’s needs on key indicators, such as per capita income, high school completion rate, opioid related hospitalizations, and internet access. The tool uses publicly available data sources and includes measures specific to opioid use (e.g., distance to nearest Medication Assisted Treatment Provider in a treatment facility) and other social drivers (e.g., housing issues). From the Explore tab, users can investigate the significance of these metrics on risk of opioid dependency and use the navigation features to explore their surrounding region using the map-based feature of the tool. The Monitor Tab provides a “report card,” compiling information from the previous page to provide a standardized/normalized score on priorities for the community. This allows state or local policymakers to quickly capture a summary of their performance that can be shared and used alongside other data sources and stakeholder input during funding allocation conversations.

Coordination and Learning: The tool also serves as a starting point for shared learning and collaboration and is designed to stimulate successful coordination across stakeholders in their efforts to implement an effective opioid epidemic response. Several interviews conducted by Duke-Margolis with local and state advocates found concerns about existing silos between government, health, social service and criminal justice systems and a fear of duplicating funding efforts and not allocating funding effectively. With that in mind, many of the resources created by this tool can be printed and shared with community stakeholders to support the use of data to catalyze discussions around the performance and needs of a county or state, and encourage collaboration on investment priorities and solutions.

Source for Resources: In addition to providing data on the current status of a county or state, the tool also provides a list of resources and use-cases (called “recovery investment opportunities”), tailored to the needs of the state or county in question. By providing recovery investment opportunities and pointing to successful applications of these initiatives, policymakers and advocates have a starting place for potential community-based opioid responses. By sharing specific examples of recovery support services, such as the Marquette County peer recovery services, or recovery courts systems, like the Substance Use Treatment and Reentry (STAR) Program, the tool helps ease the need for policymakers to reinvent the wheel in developing effective opioid responses for their community.

Next Steps

Duke-Margolis will release a subsequent guide focused on supporting local policymakers in understanding their community’s unique position and crafting a cohesive and sustainable response to the opioid epidemic in their communities through assessment, collaboration, and funding.

For more information visit the “Leveraging Opioid Settlements to Support Sustainable Community-Based Substance Use Disorder Treatment and Recovery Infrastructure” project page on the Duke-Margolis website.

Sam Repka is a Research Associate at the Duke-Margolis Center for Health Policy and former Director of Public Policy at the New York City Department of Health and Mental Hygiene.

Kristen Ukeomah is a research assistant at the Center on Health Insurance Reform at Georgetown University, where she supports research on opioid policies.

Frank McStay is an Assistant Research Director at the Duke-Margolis Center for Health Policy where his work focuses on accelerating Medicare accountable care reforms.

Rob Saunders is a Senior Research Director at the Duke-Margolis Center for Health Policy where he oversees a portfolio aimed at improving American health care delivery and the way we pay for health care, including generating practical evidence on payment and delivery reform models, translating that evidence into federal and state policy options, and engaging public and private health care stakeholders.