Opioid use disorder patients benefit from medication plus therapy

Medication assisted treatment (MAT) is one of the gold standards for treating people with opioid use disorder (OUD). But experts say the best chances for sustaining recovery come from combining MAT and behavioral health therapy. Anthem Blue Cross and Blue Shield set an ambitious goal to ensure more members receive that holistic care.

A fraction of members were receiving the recommended treatment

Anthem Blue Cross and Blue Shield (Anthem BCBS) analysts discovered that only 18% of members diagnosed with OUD, likely, a majority of them millennials, were receiving this holistic treatment. So they set out to double that number.

Millennials at risk for other health problems

The stakes are high for millennials with OUD: new research from the Blue Cross Blue Shield Association finds that millennials with opioid use disorder are more likely to have other health problems. Millennials of color are also less likely to be receiving treatment. Taking a proactive approach to improving the quality of treatment could change that picture.

Eric Bailly oversees substance use disorder strategies for Anthem BCBS and is a licensed alcohol and drug counselor. He explains how they achieved their goal – and more.

A collaborative, creative approach to identifying patients and supporting doctors 

“We knew that that was going to require an all-hands-on-deck approach,” says Bailly. It wouldn’t have been practical to call up thousands of Anthem BCBS members with OUD and offer them behavioral health therapy. The team had to come up with ways to reach members where they are, and ensure healthcare providers, like primary care doctors, had the resources they need to connect them. Here’s what they did:

• Bailly says Anthem BCBS identified primary care doctors who were interested in providing this more holistic treatment as a regular part of their practice. They would be reimbursed based on the quality of the treatment they provided, enabling some to hire case managers or other staff who could help connect patients with behavioral therapy or other resources. The company also promoted the use of SBIRT (Screening, Brief Intervention and Referral to Treatment), a tool that can help doctors assess whether patients might need help with a substance use disorder.
• Anthem BCBS also identified primary care doctors who were already prescribing MAT to some patients, but whose patients hadn’t received behavioral health therapy. Those doctors received a letter offering to help connect patients with the added therapy. And Bailly says most doctors were glad to have the help.
• Finding providers and making connections wasn’t as straightforward in every region. Some rural areas lack both the number of doctors needed to prescribe MAT and behavioral health specialists. To overcome that problem, Anthem BCBS focused on regions with some of the highest rates of OUD and opioid overdose. The health plan connected interested doctors with Project ECHO, or Extension for Community Healthcare Outcomes. That’s a “hub-and-spoke” model in in which doctors with this expertise share their knowledge and review specific patient cases via regular video sessions. The model boosts local providers’ capacity to deliver specialized care in their own communities. (ECHOs exist across the country for a variety of specialties to extend the reach of best practices in medicine to underserved communities, like this one in New York state.)
• Anthem BCBS has also expanded access to telemedicine to keep patients connected to treatment during the COVID-19 pandemic.

Not resting on their laurels 

Bailly says all of these efforts have helped double the number of members with OUD who are receiving the recommended combined therapy. “But, as an organization, we aren't going to rest on our laurels,” says Bailly. “This has really helped us say, ‘how can we take this further?’”

One way, still under development, will be trying to reach members who are at risk of developing what Bailly calls a “negative health outcome” from substance use disorder, before the problem escalates. A computer algorithm will identify these members. And then, says Bailly, “as these members are generally difficult to reach by phone,” a clinical team member from Anthem will reach out by visiting them in-person to offer support.

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.