Monthly Use of Measurement-Based Care using Greenspace Mental Health tools

Participation in existing processes available within treatment sites including semi structured interviews followed by monthly use of Measurement-Based Care using Greenspace Mental Health tools

Participation in existing processes available within treatment sites including semi structured interviews

Patients will complete MBC measures with their treatment provider and follow-up surveys conducted at baseline and monthly intervals. Both providers and patients will use the Greenspace Mental Health tools to regularly assess patient-reported symptoms, review results together, and collaboratively design individualized treatment plans. Providers will implement MBC to guide treatment adjustments based on these assessments.

Change in Patient Treatment Retention: clinic-level outcome measure that tracks the duration of OUD treatment based on medications, counseling and related services, as recorded in the claims data. Specific measures are the (1) % of patients still in treatment 6 months after initiating MOUD and (2) the average number of months new MOUD patients remain in treatment (12-month follow-up window).

Change in Patient Recovery: patient-level outcome measure that evaluates progress in patient recovery obtained from survey data. The Brief Addiction Monitoring assessment question will be administered monthly to monitor substance use.

Change in Patient Quality of Life: patient-level outcome measure that evaluates progress in patient quality of life. The Patient-Reported Outcomes Measurement Information System (PROMIS-29) Instrument will be administered at baseline and at every 3 months to evaluate and monitor physical, mental, and social health via The Greenspace Mental Health tool.

The sustainment of MBC implementation is defined as the extent to which providers continue to use MBC tools with fidelity following the removal of active implementation support, based on data sourced from Greenspace and/or provider surveys. Each treatment session will continue to receive a score of "1" for documentation of MBC data collection, a "2" for documented data sharing, and a "3" for documented action informed by data. Sessions without MBC documentation will receive a "0." Sustainability is assessed by examining whether fidelity to core MBC components is maintained over time. Potential metrics include:

Percentage of sessions with completed MBC assessments during Sustainment Percentage of sessions where MBC results were reviewed with patients during Sustainment Percentage of sessions with documented action taken during Sustainment Percentage of providers meeting a predefined threshold for sustained fidelity (e.g., 80% of sessions scoring ≥2) during Sustainment

A health economic analysis will calculate net costs to Medicaid of all-cause healthcare use by the patients. These costs will be based on each patient's healthcare claims for Medicaid reimbursement. Each service unit recorded in the claims data will be converted to its 2028 $US value and summed to create a total cost in $. In addition to costs from Medicaid patient claims, we will estimate the programmatic costs in the MBC+/Implementation Phase using activity-based costing which collects resource data (staff labor, space, materials, equipment, and software) and unit costs (wages, prices, subcontract amounts) needed to implement MBC+. Using the net Medicaid costs and Patient Treatment Retention outcome, we will estimate the cost-effectiveness of MBC+. Cost-effectiveness is the ratio of the difference in costs to the difference in outcome between the MBC+ sample and the MAU sample. In this case, that is the cost to Medicaid needed to improve treatment retention rates by 1 add'l % point.