While the number of individuals who are receiving medication assisted treatment (MAT) has increased over the years, and regulations for prescribing MAT medications have loosened slightly (see Medicaid Payments For Opioid MAT Drugs Nearly Tripled Over Past Six Years and SAMHSA Training To Allow Nurse Practitioners & Physician Assistants To Prescribe Buprenorphine), it is still difficult for consumers to get treatment (see Untangling The Access Issues For Addiction Treatment and The Stigma Of Addiction Treatment Medication). Both payers and health plans are looking for more provider organizations that offer community-based MAT programs. And based on recently-released data, we don’t expect this pressure to alleviate in the next few years, as the data suggests opioid deaths reached a new annual high in 2017, of 72,000 (see Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017).
With this market situation, the executive teams of many health and human service organizations are considering adding or expanding MAT services as part of their portfolio management. How to make that work? I heard from the experts at The 2018 OPEN MINDS Management Best Practices Institute in the session, A Provider Organization’s Guide To MAT: How To Incorporate Medication-Assisted Treatment Into Your Model Of Care, facilitated by OPEN MINDS Senior Associate Annie Medina. The session featured Christopher Yadron, Ph.D., Vice President of the West Region, and Administrator of the Betty Ford Center at the Hazelden Betty Ford Foundation; and David Lisonbee, President and Chief Executive Officer at Twin Town Treatment Centers.
Hazelden Betty Ford and Twin Town Treatment operate two distinct MAT models. Hazelden Betty Ford has included MAT throughout its continuum of care—including residential and outpatient treatment. All levels of care share the same treatment approach—the Comprehensive Opioid Response with the 12 Steps (COR-12) program. The COR-12 program focuses on using the 12-Steps in conjunction with either extended release naltrexone or buprenorphine/naloxone.
Twin Town operates a different model, providing only the outpatient therapy component of MAT. The actual prescription services are provided via collaboration with another provider organization. In addition to providing therapy services, Twin Town acts as the care coordinator—making referrals, ensuring appointments are made, and exchanging consumer data. As part of their model, the goal of the Twin Town program is to have the initial assessment and medication administration on the same day, or as close as possible.
I left the conversation with a couple of big takeaways in mind. As we move to a new model of addiction treatment, the regulations and operating standards in different states and the reimbursement structure are an issue. And, collaborations are essential to linking specialty services to the rest of the health care system.
Understand State Regulations & Operating Issues—Before provider organizations incorporate MAT into their service lines, it’s important to understand the specific state-related regulations and operation standards. While states have been loosening their restrictions on the provision of MAT (see The State ‘Crazy Quilt’ Of Opioid Treatment Policy), many antiquated rules are still in place. For example, Mr. Lisonbee explained that in California, Twin Town is not able to provide medical services because they are an outpatient addiction treatment provider organization. This provision excludes them from providing MAT.
Review Reimbursement Rates—The cost of providing MAT is high, but reimbursement may not be high enough to cover the cost. Both Mr. Lisonbee and Dr. Yardon noted that the cost of prescribing MAT is expensive and is reimbursed at a low rate. Dr. Yardon noted that for them, MAT is a very difficult service line to get to break even. Because this varies by state, by payer, and by health plan, it’s important to know the rates in your states and make sure they align with your unit costs, before incorporating MAT into your service lines.
Build Collaboration In The Community—Regardless of the MAT model, it is important for organizations providing MAT services to develop partnerships and linkages to complimentary organizations. Mr. Lisonbee talked about how Twin Towns to develop relationships with primary care organizations in the community. They do this through non-exclusive relationships, marketing, and cross-referring agreements. Dr. Yardon also spoke to the importance of developing partnerships. For many consumers from Hazelden Betty Ford, they may come to one of their facilities for treatment, but when they return home, treatment needs to continue in the community.
Despite a shift in thinking about addiction treatment and the necessity of these services, the high cost and the inability of some organizations to “go it alone” will place market pressure on service provider organizations who can’t simply ignore either these consumers, or this form of treatment. We are seeing more consumers with addiction issues able to get treatment through Medicaid–opening up the potential to implement or expand new service lines and provide addiction benefits to new populations. For provider organizations not yet operating in the addiction treatment space, new collaborations and partnerships with other organizations as part of a comprehensive care coordination strategy might need to include a renewed look at MAT.
For more on how MAT fits into the addiction treatment landscape, check out these resources from the OPEN MINDS Industry Library:
- The Stigma Of Addiction Treatment Medication
- For Addiction Treatment, Medication & Beyond
- The State ‘Crazy Quilt’ Of Opioid Treatment Policy
- Residential Addiction Treatment-The Opportunity In Changing Medicaid Policy
- Untangling The Access Issues For Addiction Treatment
- Jumping The Addiction Treatment Gap
- The Framework For A Marketing Strategy For Addiction Treatment Programs
- Buprenorphine & Methadone – Do We Actually Need To Increase Treatment Capacity?
- Addiction & Hospital Utilization – The Endless Loop?
- Keeping Up With The Changing Medicaid Addiction Treatment Landscape
For even more, join us at The 2018 OPEN MINDS Executive Leadership Retreat in Gettysburg, PA on September 19 for the session, “Next Generation Models For Health Plan Behavioral Health Services”, featuring Debra Smyers, Senior Vice President, Health Services, Sunshine Health.