Over the past decade we’ve seen some pretty dramatic changes when it comes to addiction treatment – new treatment models and new technologies are changing how we deliver services and payer preferences for more integrated, community-based care are changing where we deliver services. A growing acceptance of medication-assisted treatment (MAT) approaches (see A New Era In Addictions: Medication Assisted Treatment and The Politics Of Addiction) and a move away from residential and inpatient care in a health and human service market increasingly being driven by value (see Pay-For-Value & Mental Health Treatment – Reading The Tea Leaves), means we’re seeing a whole new world of addiction treatment models of care.
What do these new treatment models look like? Recently at The 2016 OPEN MINDS Strategy and Innovation Institute, I had a chance to learn about two organizations implementing new addiction treatment models during two different sessions – Addiction Treatment Transition? A Review Of The Emerging Models Replacing Residential Treatment, which featured Maks Danilin, Strategic Account Executive, Aware Recovery, Inc.; and How To Move From Idea To Action: A Guide To Building Successful Partnerships With Managed Care Organizations, which featured Andrew F. Vitullo, Executive Director, BioCare Recovery.
Mr. Danilin talked about Aware Recovery’s unique in-home addiction treatment model, which follows the consumer for the course of a year, and provides what Aware Recovery calls a “phased continuum of addiction home-based treatment” that combines outpatient care with “the intense diagnostic curriculum and accountability of inpatient care.” Services include ongoing medical care (managed by a nurse), daily coaching, therapeutic family assessment, wellness coaching, and educational consultation. Aware Recovery Care is an in-network provider with Anthem Blue Cross Blue Shield plans, and some private health insurers are now providing full or partial reimbursements for those under this program.
To provide this level of care, Aware Recovery builds a team of professionals around the consumers, including an addiction psychiatrist, a licensed therapist, a physical therapist, an occupational therapist, legal assistance, and a nurse. In short, the program treats addiction like a chronic condition and employs a team of health care professionals to help consumers. In addition to the above positions, the program uses a certified recovery advisor to monitor the consumer, and provide wearable monitoring devices for alcohol monitoring, GPS tracking, biofeedback, and heath trackers.
While large scale results are not yet available (the organization claims rates of recovery 350% above the national average), Aware Recovery will soon start a two year clinical trial with Yale University to evaluate efficacy of the Aware Recovery Care program when compared to a control group.
Mr. Vitullo shared his experience developing a treatment model at BioCare Recovery that combines MAT with individual, family, and group counseling sessions – over no pre-determined timeframe (average length of engagement is 13 months, with utilization of services ranging from four to 18 times per month). The program also focuses on adherence to treatment and allowing consumers to step down their addiction treatment – from inpatient to residential to partial hospitalization to outpatient – to one encounter a month. If a relapse seems likely or happens, on the other hand, services can once again be ramped up to the appropriate level. Focusing on adherence in this model is important, because as consumers step down their need for treatment, more and more of them disengage
In response to that disengagement, BioCare created a model that spans the intensive outpatient to general outpatient continuum. BioCare Recovery develops an individualized treatment plan for each consumer combining MAT and the counseling services, and the number of hours that a patient receives services depends on their treatment needs. Services can be dialed up or dialed down within 24 hours, depending on where the consumer is in their recovery or if they’re experiencing external factors that might lead to relapse.
Mr. Vitullo reported that 90% of participants in the program complete medically managed outpatient detoxification. BioCare Recovery began as a private pay organization, but now has a case rate contract with Optum Behavioral Health (UnitedHealth). (For more on Mr. Vitullo’s presentation, check out Four Keys To Success With MCO Contracting).
Like most specialties in the health and human services field, change is coming to addiction treatment – these two organizations represent what will most likely be the new model for addiction treatment in the future. Over the next couple years, we can expect a continued need for evidence-based programs that provide addiction treatment in a community-based setting that engages consumers in their own care.
For more on the changing addiction treatment landscape, make sure to join the OPEN MINDS team on August 24 at The 2016 OPEN MINDS California Management Best Practices for the session, “Expanded Coverage For Addiction Treatment: Finding The Opportunities With The Drug Medi-Cal Organized Delivery System.”