In my many discussions with executive teams, they often talk about their “creative” or “innovative” programming and their concerns about whether they have adopted the right innovation. One such innovation is medication assisted treatment (MAT)—the adoption of which has progressed in the market in “fits and starts.”
On the bright side, we have seen a lot of policy that is supporting MAT in recent years. A quick rundown of “available” money includes Congress’ 2018 approval of the omnibus spending bill that appropriated $3.3 billion to address the opioid and mental health crisis in fiscal year 2018 (see How Far Does $3.3 Billion Go?); the Substance Use Disorder Prevention That Promotes Opioid Recovery & Treatment For Patients & Communities Act (SUPPORT Act) that directs the Centers for Medicare & Medicaid Services (CMS) to end the Medicaid exclusion on addiction treatment at IMDs (see CMS To Allow State Medicaid Plans To Cover Residential Addiction Treatment); and at the state level, North Carolina, North Dakota, New Jersey (see The Moving Medicaid Addiction Treatment Market), and Kentucky (see Kentucky Medicaid To Cover Methadone Treatment Services) have all recently added MAT.
Also among the good news around the opportunity for addiction treatment providers, is that payers and health plans are looking for more provider organizations that offer community-based MAT programs (see The Moving Medicaid Addiction Treatment Market and Making MAT Part Of Your Service Line Portfolio). The use of MAT has increased last year, from 44% of organizations using it in 2017, to 59% in 2018 (see The Innovation Conundrum). The use of one medication, naloxone, has increased 484% between 2017 and 2019 (see Naloxone Prescriptions Increase 484% Over Two-Year Period). And last month, a new report from the National Academies of Sciences, Engineering, and Medicine found that consumers who receive longer-term treatment with medication for opioid use disorder (OUD) have better treatment outcomes and are 50% less likely to die (see Medications for Opioid Use Disorder Save Lives and Medications to Treat Opioid Addiction Are Effective and Save Lives, But Barriers Prevent Broad Access and Use, Says New Report).
But while the number of consumers receiving MAT has increased over the years, this approach still meets with enough resistance that many consumers are unable to receive this treatment (see Untangling The Access Issues For Addiction Treatment and The Stigma Of Addiction Treatment Medication). Research also shows that only 60% of individuals with an opioid dependence are able to access MAT (see If MAT For Addictions Is So Good, Why Aren’t More Consumers Using It?), and only 8% of licensed substance abuse facilities provide methadone or buprenorphine, accounting for 24% of all consumers receiving addiction treatment (see Medication-Assisted Treatment For Opioid Addiction). Another reason the adoption of MAT has been slower than expected is that only four U.S. states (California, Minnesota, Oregon, and Rhode Island) have essential health benefits (EHB) benchmark plans that provide coverage for comprehensive addiction treatment— 45% of EHBs did not cover at least one medication used in MAT (buprenorphine, methadone, naltrexone) or naloxone, and 20 plans did not cover naloxone (see Only Four States Have Essential Health Benefits Benchmark Plans That Meet PPACA Standards For Addiction Treatment).
This has proven especially problematic as the “opioid epidemic” is estimated to have cost $1 trillion since 2001 (including $95.8 billion in 2016), with opioid-related hospitalizations among older adults increasing by 34%, opioid-related emergency department visits increasing by 70%, and the overdose deaths involving prescription opioids rising from 3,442 in 1999 to 17,029 in 2017 (see Opioid Clarity?).
This promising but still problematic landscape was up for discussion at The 2019 OPEN MINDS Strategy & Innovation Institute session, Addressing The Opioid Crisis: An Opportunity For Innovation In Serving High-Risk Consumers, featuring Devin A. Reaves, Co-Founder & Executive Director for Pennsylvania Harm Reduction Coalition; and Paul Bacharach, President & Chief Executive Officer at Gateway Rehab. The lesson of the day-provider organizations need to produce more meaningful data that supports innovative service approaches, as well as the conjunction of behavioral health and physical health.
Mr. Bacharach noted the importance of MAT in future strategy—”Last year our eyes were really opened as we received definitive data from one of the large medical insurers. They pulled data both from internal information and a lot of literature and we realized we need to up our game when it came to MAT in our program.” Gateway Rehab is a rehabilitation treatment system that covers 15 locations in Pennsylvania and Ohio, and serves 1,700 patients daily-services include individual, family and group counseling; cognitive-behavioral therapy (CBT); twelve-step facilitation (TSF); and MAT.
The challenge for Gateway and others, according to Mr. Bacharach, was coming from a market history and organizational culture that didn’t value MAT as a replacement for total abstinence—a hurdle that was overcome only with more data. “We have a lot of people on our board that have gone through the traditional methods and thought you couldn’t replace one substance with another,” he said. “But when they saw this data, they realized we need to incorporate this approach.”
The task for executive teams is to first assess the effect of these opportunities on competitive strategy, market positioning, and sustainability—and ask how do you built the data-driven argument that will pursued both your internal stakeholders, as well as payers and health plans? Despite what looks like a very large shift in thinking, adopting this approach isn’t anything but a sure thing-high costs will limit some service delivery providers, as will imperfect understandings of either the law, the payment structures, or how to navigate a market that may have a need larger than your current organization is able to serve.
For more resources on substance abuse disorder, check out these resources in the OPEN MINDS Industry Library:
- Health Plan Strategy Meets The Opioid Crisis
- A Mosaic Solution To The Opioid Challenge
- Opioid Addiction By The Numbers
- The Stigma Of Addiction Treatment Medication
- For Addiction Treatment, Medication & Beyond
- The State ‘Crazy Quilt’ Of Opioid Treatment Policy
- How Far Does $3.3 Billion Go?
- The Privacy Rule For Addiction Treatment Is Final
- Residential Addiction Treatment-The Opportunity In Changing Medicaid Policy
- Untangling The Access Issues For Addiction Treatment
For more join me on August 14 at The 2019 OPEN MINDS Management Best Practices Institute for the session, “Implementing Provider Rating Scales For Substance Use Disorders: Payer Pilot Results & Impact On Benefit Design,” featuring: Samantha Arsenault, MA, Director, National Treatment Quality Initiatives, Shatterproof; Eric Bailly, LPC, LADC, Business Solutions Director, Anthem, Inc.; and Doug Nemecek, M.D., MBA, Chief Medical Officer – Behavioral Health, Cigna.