CareFirst BlueCross BlueShield is joining forces with Navigator Healthcare on a new partnership aimed at helping members find appropriate care for substance use disorder (SUD).
As part of the deal, CareFirst’s members can call the Navigator Healthcare team 24/7 to help them find the proper, in-network care for their SUD needs.
The collaboration reflects the rise in payer efforts to help patients better navigate their care. Specifically, this partnership aims to help members navigate SUD care’s complex and often confusing world.
“I think, like a lot of folks in health care, we assume, incorrectly, that consumers know all the special terminology and acronyms that we use in our day-to-day lives,” Brian Wheeler, vice president of provider collaboration and network transformation at CareFirst, told Behavioral Health Business. “We all talk internally with our behavioral health and substance use team … about how ‘this patient needs to go to residential treatment, or detox, or this one needs medication-assisted therapy, or a partial hospitalization program.’ What the public knows is people go to rehab. They don’t know anything more than that.”
CareFirst is a nonprofit health company and an independent licensee of the Blue Cross Blue Shield Association. It serves 3.6 million individuals and employers in Maryland, Washington, D.C., and Northern Virginia.
One of the key objectives of this new payer-startup relationship is to help patients understand the system better and access the right level of care. It is also intended to help speed up the process.
“It’s a chronic condition. Very complex individuals left to their own devices will not necessarily land in evidence-based programs,” Deb Adler, CEO and founder of Navigator Healthcare, told BHB.
Navigator Healthcare operates a 24/7 resource center staffed with independently licensed clinicians, who work with the payer’s members, helping them understand their treatment options in layperson’s terms, Adler explained.
“And then, through our platform, we’re able to connect them with on-demand appointments for substance use treatment within 48 hours of that call,” she continued. “So it’s the same day, next day, appointment guarantee.”
New York-based Navigator Healthcare was founded in 2019. It offers personalized navigation services for individuals impacted by SUD.
The Navigator Healthcare team works with members, sometimes over several months, as they transition through levels of care. For example, the team may help a person move from a residential program to a partial hospitalization to an intensive outpatient program. It will also help patients who need to step back up into a higher level of acuity care if required.
The program is geared at patients aged 13 and over and will be available to CareFirst’s commercial, Medicare and Federal Employee Program (FEP) members. There is no out-of-pocket expense for the member.
Navigator Healthcare will work with individuals seeking care, family members, primary care physicians, emergency room staff trying to place a patient and law enforcement advocating for a patient.
In addition to helping patients find treatment, Navigator Healthcare can also closely monitor SUD providers’ capacity. This allows the it to send patients to providers with availability.
This news comes as rates of SUD continue to spike in the U.S. About 46.3 million people aged 12 and older have SUD, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Still, 94% of individuals with SUD didn’t get treatment.
“This is a service that is going to actually save people’s lives,” Wheeler said. “And with what we see out there today, with opioids and fentanyl, … I think that’s extremely likely that that’s going to be the case.”
This isn’t CareFirst’s first deal with a navigation startup. Over the summer, the payer teamed up with Headway, a company that matches patients to mental health clinicians, on a program designed to help members more easily find behavioral health providers.
“It is difficult for consumers to navigate the complex health care system in behavioral health or substance use, or physical medicine,” Wheeler said. “So we look for these opportunities to make it more plain and [easier] to navigate, to give people the care that they need.”
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