Addiction treatment varies widely, from inpatient to outpatient to medication assisted therapies. But that treatment is often fragmented, leaving patients to navigate a complex system on their own. What’s more, health plans have traditionally covered that care on a fee-for-service basis, prioritizing episodic treatment instead of long-term, coordinated care. Anthem Inc., along with a coalition of experts, is piloting a new model that incentivizes healthcare professionals to keep patients focused on long-term recovery.
Questions and Answers with Eric Bailly, Substance Use Disorder Strategies, Anthem Inc.
Eric Bailly oversees substance use disorder strategies for Anthem, Inc. (Anthem) and is a licensed alcohol and drug counselor. In this Q&A, Bailly explains how Anthem Blue Cross Blue Shield is piloting a new patient-centered medical home for people with substance use disorder at a healthcare system in Connecticut. The model reimburses healthcare providers for improving a patient’s likelihood for long-term recovery.
Health of America (HOA.COM): What would you like to change about substance use disorder treatment?
Eric Bailly: A friend with substance use disorder shared his experience of what it was like when he entered the system. My friend was in withdrawal. He said the hospital detoxed him and sent him on his way with no plan, no follow up appointments. That’s not coordinated care. It’s not focused on helping a patient achieve long-term recovery.
I’d like to see treatment evolve from being episodic and fragmented to something that looks more like what we’re beginning to provide for people with chronic diseases. That’s what a medical home looks like: coordinated care, provided by healthcare professionals who are held accountable for supporting that patient in achieving long-term recovery.
HOA.COM: So how is your new addiction recovery medical home model different?
BAILLY: It’s about incentivizing recovery over relapse. The model recognizes that patients may come into treatment in various stages of readiness for change. Maybe they show up in the ER and need to be detoxed from alcohol. Maybe they visit a primary care doctor and ask for help coming off of opioids. This model recognizes, number one, that patients will have more acute needs when they first seek recovery; and number two, that each needs an individualized treatment plan from the get-go. It also recognizes that they may relapse and need to return to a higher level of care. Doctors will receive kind of a bundled payment to meet all of those needs – with a few different payment tiers that take into account the fact that some services are more expensive than others. That gives doctors the flexibility to provide patients the services they feel are necessary and incentivizes doctors to keep patients engaged in care and on the path to long-term recovery.
It’s important to note that there’s still work to be done when it comes to developing evidence-based addiction treatment. But my experience has taught me there’s no single path recovery. And that is why we need to support doctors by giving them the flexibility to develop individualized treatment plans. Patients may need a mix of, or just one of the following, elements: detoxification, residential treatment, intensive outpatient programs, weekly support group meetings, medication, the support of a peer recovery specialist, ongoing psychiatric care, and more.
HOA.COM:Addiction is now the leading cause of death in America for people under 50. It’s clear that not enough people are receiving treatment or able to sustain long-term recovery. Is that an access problem, a quality of treatment problem, or more?
BAILLY: It’s a combination. This new program (officially known as The Addiction Recovery Medical Home – Alternative Payment Model) was developed by a collaborative alliance of prominent healthcare organizations and experts in the addiction field, including Anthem. What we came away with is that we have the tools, the capacity and the expertise to help many more people into recovery. But we have to work harder to organize the way we care for people with substance use disorder, putting them at the center, and aligning the way we pay healthcare providers for treating them with high quality outcomes, the way we do for patients with other chronic diseases. We’re already putting this new treatment model to the test. And for me, this kind of coordinated care is what can lead to long-term recovery and the chance to live a long, healthy life.
Anthem Blue Cross and Blue Shield is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.