Tackling Substance Abuse, Opioid Crisis: How Health Insurance Providers are Increasing Access to Addiction Treatment

In a news brief published by AHIP, initiatives employed by health insurance providers AmeriHealth Caritas, Geisinger, Horizon Blue Cross Blue Shield of NJ (BCBSNJ), and UPMC plan to address issues ranging from the opioid crisis to behavioral healthcare access.

The impact of substance use disorders (SUD) and the opioid crisis have substantially affected the healthcare system, social services, communities, and the economy, with substance abuse being attributed to costing the US $740 billion annually through crime, lost work productivity, and healthcare. Daily averages on substance abuse find that 130 people die from opioid-related overdoses and 3900 people will use a prescription opioid outside of legitimate medical purposes.

As the news brief details, key challenges exist to further improve and expand SUD treatment, such as insufficient capacity to treat those in need of care. This disparity in access to behavioral healthcare has been found to be worsening among employer-sponsored health plans, warranting interventions to combat this trend. Addressing these concerns, health insurance providers are employing strategies to increase capacity for SUD treatment, while also ensuring that members have access to high-quality treatment and care.

Novel Approaches by AmeriHealth Caritas to Combat Opioid Crisis

Developed by AmeriHealth Caritas, the “New Beginnings: Addiction and Recovery Medical Home” SUD program serves to improve preventive treatment for opioid abuse through a bundled payment approach that provides innovative solutions for addiction and recovery services for those most in need. Often, a health insurance provider becomes aware of a patient’s SUD when the member has overdosed and is admitted to an emergency department, but through its SUD program, health systems are implementing new strategies that improves patient engagement in treatment and recovery services to combat the opioid overdose epidemic.

The model will deliver treatment to patients through a team of primary care providers, behavioral health providers, and SUD specialists, that will prioritize multidisciplinary care. Patients are enrolled for 12 months, provided services including recovery care planning, behavioral health screening, and management of physical health co-morbidities, and are encouraged to stay in the program for several years to support long-term recovery.

Geisinger Health Plan Drives Value for Members, Strengthens Communities

The opioid epidemic has been shown to devastate communities, leading to a shortage of clinicians who treat SUD and opioid use disorder (OUD). Geisinger is addressing these shortages in SUD and OUD care by working closely with partners, notably the Centers of Excellence to deliver medication-assisted treatment (MAT) and behavioral health services.

Geisinger promotes a whole-person approach to combating SUD, with the primary goal being to integrate both addiction medicine and behavioral health services into primary care so an individual can receive care for SUD, behavioral health, and physical health all in 1 setting. Eliminating the stigma behind SUD and OUD is an issue being addressed by Geisinger as well, with physicians being given structured education on the topic and patients being given consumer-oriented content to increase awareness. All of these strategies serve to address a key element in SUD and OUD care: providing patients with effective care in a timely manner.

Horizon BCBSNJ Tackles Underlying Behavioral Health Issues

In accordance with growing issues related to substance abuse, Horizon BCBSNJ has increased its funding for SUD treatment by 350% since 2013. The health insurance provider have targeted 1 of the sources of substance abuse, which are members’ underlying behavioral health issues. To delineate members who may have undiagnosed or undertreated behavioral health issues, Horizon BCBSNJ partnered with Quartet, a healthcare technology company that uses analytics to identify patients who may be suffering from SUD or are at high risk. The partnership educates physicians on the data and how to interpret it, further implementing its use in primary care.

Horizon BCBSNJ have additionally launched a pilot project for individuals suffering from SUD and/or serious mental illness, which features services through Certified Community Behavioral Health Clinics (CCBHBC). These CCBHBCs can include MAT, ambulatory withdrawal management, outpatient therapies, peer support, and use of the behavioral health medical home programs. The pilot project seeks to ensure access to care for patients who have historically experienced fragmented care or uncoordinated services, highlighting Horizon BCBSNJ’s commitment to addressing underlying behavioral health issues.

UPMC Expands SUD Treatment Capacity by Hosting DEA Waiver Training

Providing quality care to patients with SUD or OUD is hindered amongst physicians due to stigmas or insufficient training, however, the absence of the required DEA waiver to prescribe some MAT remains a major obstacle for willing providers. UPMC partnered with the Pennsylvania Department of Drug and Alcohol Programs to target efforts to expand access, including recruitment strategies tailored to physical health providers in becoming waivered and providing training for physicians, nurse practitioners, and physician assistants in high-need regions in the state.

In supporting recently waivered physicians, UPMC employs monthly sessions on prevalent issues, provides access to webinars and meetings, hosts monthly case discussions, and offers access to a 24/7 hotline staffed by addiction medicine providers. While stigma remains a barrier to behavioral healthcare, UPMC’s focus on providing willing physicians with MAT can initiate care within at-risk communities.