Transforming Our Health System: Bringing Drug and Alcohol Treatment into the Fold
Navigators and assisters have hit the streets for round two of open enrollment for health insurance plans available as a result of the Affordable Care Act. With more people gaining access to care, this is a crucial time to strengthen the way we provide and pay for health care. Integrating services for drug and alcohol problems with other care can play a big role in transforming the health system and meeting goals of better care, better health and lower costs. The Centers for Medicare and Medicaid Services (CMS) are promoting this change in Medicaid, following a few states that are leading the way. Improving care for substance use disorder under Medicaid, which now covers at least 8 million people with substance use disorders, has the potential for profound change nationwide.
Let’s take a look at some service delivery innovations already underway. Washington state is using a prevention and early intervention model called SBIRT – screening, brief intervention, and referral to treatment to help prevent and treat drug and alcohol problem. This initiative reduced hospitalizations among Medicaid enrollees and led to significant savings for the state. Massachusetts saved money and improved care for Medicaid enrollees through medication-assisted treatment (MAT), which combines counseling with prescription drugs that blunt addiction. The research for MAT is strong but states are often reluctant to support it because it conflicts with traditional abstinence-based treatments. Massachusetts has opened the door for other states to use this evidence-based practice.
CMS is launching an initiative to promote more of this type of innovation by highlighting state successes, providing technical assistance and building a cross-state learning community. CMS spotlighted these best practices in a recent memo:
- Provide a comprehensive benefit package for substance use disorders ranging from prevention to treatment to recovery services.
- Integrate care for physical and behavioral conditions, incorporating the whole health of the patient by using health homes, primary care medical homes, and other integrated care models.Coordinate care across transitions in both physical and behavioral health care.
- Implement prevention efforts and strategies to alleviate prescription drug misuse.
- Head off alcohol and drug misuse in youth, including strategies in primary care such as Screening, Brief Intervention, and Referral to Treatment (SBIRT).
Advocates should urge their states to sign up for the Medicaid Innovation Accelerator Program (IAP) to learn from other states and get technical assistance from CMS. The program will feature monthly calls and webinars as well as hands-on support in preparing the technical documents (waivers or state plan amendments) that may be needed to help transform Medicaid to better treat substance use disorders. The deadline for submitting an “Expression of Interest” is this Friday, November 21. CMS is requiring stakeholder input from states that are selected to participate.
This initiative in Medicaid, coupled with other transformation projects, such as Accountable Care Organizations and the demonstration projects for people eligible for both Medicaid and Medicare, will help make our health system work better for all of us, including individuals with substance use disorders.
Impressive enrollment and reenrollment efforts are expected over the next few months. Let’s leverage this momentum and ensure all consumers – especially those with behavioral health care needs – have access to a coordinated and effective health care system.
Melissa Ough, policy analyst
and Alice Dembner, project director