At no time in the history of our specialty have our diplomates faced greater complexity or more rapid transformation of the health care delivery system,nor such incredible uncertainty and dynamism in their future roles within it.1In addition to tackling the most complex clinical encounters, 2 graduates now leave training expected to immediately under-stand a health system shaped by such towering forces as rapidly increasing consolidation, value-based and alternative payment models, measurement, internecine scope-of-practice battles, disruptive delivery innovations, genomics, big data, artificial intelligence, and machine learning.

Introduction: Opioid use disorder (OUD) is a major and growing public health concern, and Medicare patients have nearly double the proportion of OUD prevalence compared with those with commercial insurance. This study examines provider-level characteristics to delineate the wide variation behind buprenorphine provision, which is the mainstay of medication-assisted treatment for OUD.

Methods: Using Medicare Part D Public Use Files claims data from 2013 to 2016 in all states, we assessed prescribing patterns of buprenorphine formulations for the specialties of family medicine, internal medicine, psychiatry, and general practice.

The U.S. lags behind other developed countries in the use of indices and novel reimbursement models to adjust for social determinants of health (SDH) in medicine. This may be due in part to the inadequate body of research regarding outcomes after implementation of healthcare payments designed to address SDH. This perspective article focuses on four models employed both internationally and domestically to outline the implementation, successes, limitations, and research needed to support national application of SDH models. A brief history of prior models is introduced asa primer to the current U.S. system. Internationally, the United Kingdom and New Zealand employ small area indices to adjust healthcare dollar allocation based on increased social need in an area.