As the opioid epidemic rages on and the behavioral health workforce shortage persists, stakeholders are getting creative when it comes to tackling addiction and other behavioral health conditions.
That includes insurers, some of whom are piloting and pioneering creative approaches designed to curb those problems.
America’s Health Insurance Plans (AHIP) highlighted some of those strategies last week. AHIP is a trade association representing health insurance companies known for Medicare Advantage and other CMS-governed health plans.
While the featured approaches vary in design, they all share one common goal: to improve access for those struggling with substance use disorder (SUD) and other behavioral health conditions.
Such initiatives are especially important for insurers, who don’t have a great track record when it comes to covering behavioral health treatment and services.
In fact, a recent report found that parity gaps are widening, with U.S. employees far more likely to go out of network and see lower reimbursement for behavioral health services than for physical health services.
At the same time, 130 people die every day from an opioid overdose alone — not to mention deaths attributable to other behavioral health conditions — according to the Centers for Disease Control and Prevention (CDC).
Those findings make the following insurer’s strategies even more noteworthy.
In Washington, D.C., where AmeriHealth Caritas provides Medicaid managed care to more than 12,000 people, the insurer has launched an SUD program called “New Beginnings: Addiction and Recovery Medical Home.”
The program creates bundled payment models for addiction and recovery services. Primary care providers, behavioral health providers and SUD specialists all work together to provide treatment, which includes recovery planning, behavioral health screening and management of physical comorbidities, among other services.
The goal of the model is to create incentives and shared responsibility, which are meant to lead to the best outcomes for recovering SUD patients.
The program lasts for up to 12 months, but patients are encouraged to stay in the program for years. Use of peer support and care managers are also encouraged.
Geisinger Health Plan
In Pennsylvania, Geisinger is working with partners such as the state’s Centers of Excellence, which are health homes that work to coordinate care for people enrolled in Medicaid.
The goal is to contract with practices that can provide medication-assisted (MAT) services for members. Geisinger then works also to expand access to SUD treatment via telehealth.
Additionally, the insurance provider is working to better integrate addiction medicine and behavioral health services into primary care. To do that, Geisinger educates primary care providers about treating patients with SUD through direct conversations and partnerships with community coalitions.
It also provides informational content about SUD resources directly to consumers, partnering with organizations such as the United Way to spread the word.
Finally, Geisinger does warm handoffs to ensure people with SUD have the resources they need to foster recovery. After people are admitted to the ER for reasons related to SUD, the insurer sets them up with peer support, a short supply of medication and a case manager to help manage their recovery.
Horizon Blue Cross Blue Shield of NJ
Meanwhile, Horizon Blue Cross Blue Shield of NJ has put their money where their mouth is.
Since 2013, the insurer has increased funding for SUD treatment by more than 350%, according to AHIP. Horizon partners with Quartet Health to use analytics to identify people who are suffering or at risk for SUD and other behavioral health conditions.
Quartet is a technology platform that brings together physicians, mental health providers and insurers, allowing them to share information and better coordinate care.
In addition to using the platform for care coordination, Horizon uses Quartet to connect patients to providers.
Horizon has also launched a pilot to serve people with SUD and serious mental illness. Through the pilot, Horizon offers MAT and other services through Certified Community Behavioral Health Clinics (CCBHBC) and works with primary care practices to coordinate care for patients.
UPMC — previously known as the University of Pittsburgh Medical Center — is working to expand patients’ access to behavioral health services by bolstering the workforce, specifically when it comes to MAT.
The shortage of qualified clinicians is frequently cited as a pain point for behavioral health providers. In fact, by 2025, projections estimate the field could be short by more than 250,000 full-time workers.
In an effort to offset the shortage, UPMC is working with the state of Pennsylvania to recruit physical health providers to become qualified to provide MAT services — with the hopes that those providers can then help train other prospective MAT clinicians as well.
The state received a grant in 2017 to help with those efforts, which include offering trainings remotely and incentives to complete MAT training programs, as well as providing various forms of ongoing education and support.
The insurer also educates providers and patients about MAT, as well as testing alternative payment models for SUD treatment, according to AHIP.