PROJECT SUMMARY The crisis of opioid misuse, addiction, and overdose has had a devastating impact on communities, with more than 400,000 people killed from an opioid-related overdose between 1999 and 2017. Because the opioid epidemic is a complex and heterogeneous issue, effective responses are required from public and private stakeholders, as well as healthcare systems and communities. The healthcare system has played a partial role in creating the crisis through liberal use of prescription opioids for pain, and healthcare providers and organizations have a unique and important role to play in tempering the crisis. By focusing on the dyad of both opioid prescribing as well as opioid use disorder treatment, healthcare organizations and policymakers may be able to effectively combat this national epidemic. In order to do so, however, it is necessary to first understand how various organizational characteristics impact prescribing practices and care for patients with opioid use disorder across the continuum. In this proposed research, we will use multiple waves of the National Survey of ACOs and the National Survey of Healthcare Organizations and Systems, linked to national Medicare and Medicaid claims, as well as American Hospital Association Annual Survey data to assess the role of healthcare organizations in general, and payment and delivery reforms specifically, on opioid use disorder prevention and treatment. After fielding another survey wave to create longitudinal responses on opioid related questions, we will 1) estimate changes in potentially hazardous prescribing, opioid use monitoring, and overdose associated with organizational characteristics, including alternative payment model participation, and 2) estimate changes in opioid use disorder treatment associated with organizational characteristics and contractual arrangements. By combining surveys on organizational response to the opioid crisis with administrative claims data, we will uncover associations between specific actions by health systems and outcomes that could influence opioid use disorder and substance use disorders more broadly. As policymakers and providers seek out new methods to ensure opioids are thoughtfully prescribed and to effectively care for patients with opioid use disorder through the traditional health care delivery system, our findings will help providers choose the most effective organizational strategies to combat the opioid epidemic.