Policy levers and delivery-system response

This work evaluates how providers respond to policy changes intended to improve access to and quality of care. Examples include Medicaid Section 1115 substance use disorder IMD waivers, Medicare coverage of opioid treatment programs, COVID-era telehealth flexibilities for opioid use disorder, prior-authorization requirements, and access to crisis intervention teams. Methods include difference-in-differences designs, a national survey of buprenorphine prescribers, and descriptive analyses of facility data.

Policy can change access when existing providers change what they offer and when providers enter or exit the market. Using a difference-in-differences design with a decomposition of facility transitions, we find that nearly 90% of the increase in residential facilities that both accept Medicaid and offer medications for opioid use disorder under Section 1115 waivers came from facilities opening and closing. Evaluations that follow only existing facilities may under- or over-predict policy effects.

Representative work

Medicaid: Increased Patient Access To MOUD In Residential Treatment Associated With Facility Openings And Closures, 2012–22

Beetham T, Newton H, Ndumele C, Fiellin DA, Busch S

Health Affairs, 44(9):1122-1130, 2025.

Difference-in-differences evaluation of Medicaid Section 1115 waivers and access to opioid use disorder medications in residential facilities that accept Medicaid.

Is access to crisis teams associated with changes in behavioral health mortality?

Newton H, Beetham T, Busch S

Health Affairs Scholar, 3(1):qxaf003, 2025.

County-level analysis linking changes in crisis-team access to changes in behavioral health mortality.

Access to Treatment Before and After Medicare Coverage of Opioid Treatment Programs

Liu R, Beetham T, Newton H, Busch S

Health Affairs Scholar, 2(6):qxae076, 2024.

Evaluation of Medicare coverage of opioid treatment programs and its association with Medicare acceptance and ancillary service availability.

Physician Response to COVID-19-driven Telehealth Flexibility for Opioid Use Disorder

Beetham T, Fiellin DA, Busch SH

American Journal of Managed Care, 28(9):456-463, 2022.

Survey of buprenorphine prescribers on telehealth use under COVID-era flexibilities and support for making those flexibilities permanent.

Association of Access to Crisis Intervention Teams with County Sociodemographic Characteristics and State Medicaid Policies and Its Implications for a New Mental Health Crisis Lifeline

Newton H, Beetham T, Busch SH

JAMA Network Open, 5(7):e2224803, 2022.

National mapping of county access to crisis intervention teams before the 988 crisis lifeline launched.

Buprenorphine Prior Authorization Removal: Low Hanging Fruit in the Opioid Overdose Crisis

Beetham T

Harvard Public Health Review, 25, 2019.

Commentary arguing for removing prior-authorization requirements for buprenorphine in the opioid overdose crisis.