Health plans will see the best results in treating substance use
disorder (SUD) by adopting a risk-sharing, value-based contracting model with
providers, experts say in a June 22 virtual panel discussion at the AHIP Institute
and Expo.
The best approach to manage SUD:
- "We know that addiction is actually a chronic
condition, and one that has ebbs and flows, and treatment is best
delivered over the course of months or years. It may be a lifelong
condition, and therefore we need to be thinking about solutions that treat
the whole person and do so over time and fit within their lives,"
said Stephanie Strong, CEO of SUD treatment provider Boulder Care.
- "We also know that addiction is profoundly
impacted by psychosocial, environmental, genetic and many other
factors." Given that, Strong said, outpatient centers can be
"effective [at] delivering things like medications for addictive
disease."
- Megan Heahlke, a senior product strategist at Premera
Blue Cross, said Premera is well aware that the inpatient modality is not
always the best choice for someone trying to manage SUD. Outpatient and
virtual SUD treatment is "one more option to let the members pick
what's right for them."
Payer-provider collaboration:
- For Premera, which has Boulder Care in its network, a
value-based SUD contract needs to include metrics that both the plan and
provider agree on. Heahlke said plans need to track that data on an
ongoing basis, collaboratively with the provider.
- Strong suggested that metrics that have traditionally
been used in evaluating SUD care need to be reexamined.
- Instead of testing, Strong advocated for tracking
"progress over time" with a "longitudinal model" based
on metrics validated by the Centers for Disease Control and Prevention.
She also pointed out that employer plan sponsors have an important role to
play in helping their employees get SUD treatment.
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