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New quality measures reveal wide variation in opioid treatment programs’ Medicaid patient retention rates

RTI opioid treatment program-level measures of retention highlight opportunities for quality improvement


RESEARCH TRIANGLE PARK, N.C. — A new study published in JAMA Network Open and authored by experts at RTI International, an independent scientific research institute, has found that many opioid treatment programs (OTPs) across the U.S. are struggling to keep patients engaged.

According to the study, at typical opioid treatment programs, 61% of Medicaid patients remained in care beyond the first month, but, among the bottom quarter of programs, only 40% remained in treatment for at least one month.

“For opioid use disorder, treatment retention is one of the strongest predictors of recovery and survival for patients experiencing opioid use disorder,” said lead author Tami Mark, Ph.D., a Distinguished Fellow at RTI. “This new measure offers OTPs a consistent benchmark that shows how their retention rates align with national patterns, enabling programs to pinpoint strengths, isolate gaps and prioritize targeted improvements.”

RTI researchers created case-mix adjusted retention measures using Medicaid claims data from 2018 to 2023. In 2023, the measures included more than 1,100 OTPs, 432,000 treatment episodes, and 261,000 patients.

The measures reveal a wide variation in OTPs’ retention rates: 

  • OTPs in the top 75% retained 73.5% of participants for 30 days, compared with 40.9% in the bottom 25%.
  • At 90 days, top OTPs retained 54.8%, while bottom‑quartile programs retained 22.2%.
  • At 180 days, retention was 40.5% in the top group and 11.4% in the bottom group.

RTI researchers Dylan DeLisle, MPH, Chelsea Katz, Ph.D.; William Dowd, Ph.D.; Daniel Barch, Ph.D.; Marianne Kluckman, MPH, also contributed to the study, which was supported by the NIH HEAL Initiative.

Read the full study

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Clinician meets with patient
Meet the Experts
Tami Mark Distinguished Fellow, Behavioral Health Financing and Quality Measurement
Dylan DeLisle Research Public Health Analyst
William N. Dowd Research Economist
Daniel Barch Researcher
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