CINCINNATI — Ohio’s fight against the opioid overdose epidemic has been more of a marathon than a sprint. In our state’s race to save lives, there have been many signs of progress — from the influx of federal dollars going to state and local treatment programs to serious efforts to further incorporate evidence-based substance-use treatment into the state Medicaid program. Preliminary opioid death numbers for 2018 track reductions in Cleveland, Dayton and many other big cities as well as other parts of the state, marking a trend from last year when the number of prescription opioid overdose deaths reached an eight-year low. Unfortunately, in 2017, the overall deaths attributed to opioids hit an all-time high as well.
But for all the critical ground it’s made, Ohio – like the rest of the nation – still has significant room for improvement in a key area that can make all the difference for patients and families: comprehensive insurance coverage for evidence-based addiction treatment.
According to the Substance Abuse and Mental Health Services Administration, only about one in ten individuals with a substance use disorder receives treatment. Even fewer receive medication-assisted treatment (MAT), which has emerged as one of the most effective ways to treat individuals with opioid use disorder and has been proven to reduce relapse and overdose deaths. MAT works by combining counseling support and behavioral therapies with the appropriate administration of FDA-approved medications meant to help patients cope with withdrawal symptoms and cravings.
Policymakers in Ohio and across the country have begun to recognize MAT as an important tool in treating addiction – and recent efforts to integrate these elements into our state Medicaid program are an important step toward widespread adoption.
There are still many barriers to overcome. One of the most significant is the fact that the current financing structure for outpatient treatment is insufficient in many ways – especially in regard to office-based opioid treatment. The fee-for-service model, which is most commonly used by insurers to pay for addiction services, does not necessarily incentivize coordinated care and in many cases is insufficient to support the resources required to identify, diagnose, and develop a treatment plan for opioid use disorder. As a result, treatment is often segregated and coordination among providers is sometimes nonexistent.
In April, the American Society of Addiction Medicine and the American Medical Association announced an innovative alternative payment model that could revolutionize how opioid use disorder treatment is delivered and covered by insurers. The Patient-Centered Opioid Addiction Treatment (P-COAT) model is explicitly designed to integrate and provide comprehensive insurance coverage for the medical, psychological, and social support aspects of addiction treatment in a way that encourages quality care while also reducing expensive emergency department visits and hospitalizations.
P-COAT would provide physicians and health professionals with the structure they need to effectively treat patients with opioid use disorder and require that the treatment delivered is consistent with national standards and known best practices.
Patients treated by a provider who uses the P-COAT model can expect to receive three types of outpatient services: office-based MAT, outpatient psychological counseling/therapy, and appropriate care coordination and social support. The model allows for collaboration between providers to deliver the full range of care.
Most importantly, P-COAT’s development was guided by a wealth of research showing that evidence-based MAT, when combined with appropriate medical and psychosocial support, is the most effective means of treating individuals with opioid use disorder. According to the latest research, health care costs were cut by more than half (to $13,500 from $31,000) for patients who received a combination of MAT and psychosocial support services compared to those who received no treatment – in part by reducing expensive emergency room visits. The model and its cost-savings potential should be welcome news for state officials tasked with ensuring federal dollars go as far as possible to save lives.
With the proper tools and resources, it is possible to achieve a future where all Americans have access to evidence-based addiction treatment. P-COAT brings us one step closer to that goal.
Dr. Shawn A. Ryan, a member of Gov. Mike DeWine’s RecoveryOhio Advisory Council, is the immediate past president of the Ohio Society of Addiction Medicine and chaired the American Medical Association-American Society of Addiction Medicine alternative payment model working group. He is also the president and chief medical officer of BrightView Health, an outpatient addiction treatment organization with sites throughout Ohio.
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