Innovative providers, collaborations and payment strategies lead to increase
INDIANAPOLIS--(BUSINESS WIRE)--Sep. 2, 2020--
To make a positive impact on consumer health and lessen the impact of the opioid epidemic, Anthem affiliated health plans pledged four years ago to ensure significantly more consumers received both drug therapy and counseling treatment in an effort to treat the whole person and achieve what are believed to be better outcomes for opioid use disorder.
Anthem met these goals by boosting the combined percentage of consumers in employer-based, individual and Medicaid plans with opioid use disorder receiving both therapies from 18 percent to 36 percent in 26 plans nationally—more than doubling the number of consumers receiving both therapies. Medicaid plans alone increased from 24 percent to 55 percent.
The goal was met just as the country commemorates National Recovery Month, which recognizes people who are in recovery and those who support them. Increasing the number of consumers receiving both therapies becomes even more relevant as the country struggles with the COVID-19 pandemic. The White House Drug Policy issued a recent analysis showing that drug overdose deaths are up 11 percent for the first four months of 2020 during the pandemic compared to the same time last year.
“It’s more important than ever that health insurers, like Anthem, are taking a leadership role and helping to ensure people receive comprehensive treatment for opioid and other substance use disorders,” said Greg Williams, a national recovery advocate instrumental in the launch of the seminal Surgeon General’s report on Alcohol, Drugs, and Health: Facing Addiction in America, and co-founder of The Alliance for Addiction Payment reform. “Medication for certain substance use disorders has the potential to save lives, but medication alone is not a panacea for long-term outcomes. The best way to promote sustained recovery is to combine the use of medication in treatment with evidence-based behavioral therapies and recovery support services.”
Anthem is committed to supporting holistic policy changes that help reduce, prevent and deter opioid use disorder, as well as those that help consumers gain better access to opioid use disorder treatment and assist in their recovery. Its health plans, working in tandem with pharmacy, have already been successful in lowering the number of opioid prescriptions filled by more than 60 percent since 2015 when prescriptions peaked.
“Opioid use disorder is a complex societal issue that will take focus and persistence to resolve,” said Dr. Charles Gross, vice president, Anthem behavioral health. “By breaking down silos and fostering greater collaboration with our care providers and other national patient and industry organizations, we are confident that together we can find solutions to help ensure our consumers have access to the best evidenced-based care for substance use disorder.”
Four years ago, Anthem’s research of pharmacy and medical claims found that only 18 percent of consumers taking buprenorphine or naltrexone were also getting the clinically appropriate counseling to successfully change behavior and assist in recovery from addiction. Anthem health plans then committed to work intensely with care providers and others to implement programs to close the gap and encourage counseling as part of all medication-assisted treatment, or MAT, services.
The American Society of Addiction Medicine and Substance Abuse and Mental Health Services Administration both advocate the use of counseling in combination with drug therapy to treat people with substance use disorder.
“Through our research, we determined there were key barriers to consumers getting the therapy they need – availability of local care providers participating in MAT, appropriate screenings at the primary care provider, and innovative approaches to recovery, including comprehensive, home-based treatment,” said Dr. Dheeraj Raina, addictionologist and Anthem medical director.
To improve the use of counseling with drug therapy, Anthem health plans:
Provide access to telehealth MAT programs in several markets to ensure convenient options and have committed to growing this access post-pandemic. About 19-25 percent of those receiving MAT began to receive their counseling via telehealth, compared with about 1 percent before the pandemic.
Monitor non-fatal overdose metrics to assess real-world impact of holistic strategies, including provider and consumer-based interventions.
Developed a program using predictive analytics to determine which members are most at risk of negative health outcomes from opioid or alcohol abuse. This program, which includes outreach to members, will expand to 17 cities in 2020.
Encourage primary care providers to become certified in MAT by standardizing reimbursement for these services between primary care and behavioral health providers.
Developed bundled payments with practices that encourage treatment for both drug therapy and counseling.
Make primary care practices aware of how to bill for early identification and screening for opioid addiction through actively encouraging the use of Screening, Brief Intervention and Referral to Treatment, or SBIRT, codes. Since 2016, Anthem health plans increased use of these codes by 12 times.
Support innovative programs, such as Aware Recovery Health, in Connecticut, Maine and New Hampshire, to study and research models that take an in-home treatment approach to recovery.
Support improving the MAT skills of primary care providers by providing access to substance abuse experts via Project ECHO in West Virginia, South Carolina and other states hardest hit by the opioid epidemic – and via provider contracts with Clean Slate and Groups Recover Together in California, Kentucky, Indiana, New Hampshire, Maine, Wisconsin and Virginia. Anthem providers nationwide can collaborate with the main Project ECHO center in New Mexico.
About Anthem, Inc.
Anthem is a leading health benefits company dedicated to improving lives and communities, and making healthcare simpler. Through its affiliated companies, Anthem serves more than 106 million people, including more than 42 million within its family of health plans. We aim to be the most innovative, valuable and inclusive partner. For more information, please visit www.antheminc.com or follow @AnthemInc on Twitter.
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Source: Anthem, Inc.