Health plans should consider various strategies to address gaps in member access to waiver-trained providers and evidence-based pain management and addiction treatment. These strategies may include contracting with providers, including specialists, to fill gaps in the existing network; supporting providers’ completion of waiver training; and providing incentives for waiver-trained providers to see at-risk members. In this section we include tools and resources to connect providers with experts in substance use evaluation and management.
How to Do It
- Contract with necessary providers to fill gaps (e.g., pain specialists aligned with Centers for Disease Control and Prevention guidelines, providers who take a holistic approach to pain management).
- Increase the number of waiver providers in your network and increase willingness of waiver providers to see patients.
- Provide incentives for necessary providers to see patients.
Health Plan Stories
Alameda County Health Care Services Agency
After meeting this goal, HCSA required that providers maintain their numbers of waivered prescribers and demonstrate that each was prescribing buprenorphine to at least 5 patients. In 2017, the requirement grew to 10 patients receiving buprenorphine, and the sites had to accept referrals from the ED-Bridge program. Building on its success to date, the current contract requires providers to show they have a plan for safe harbor for anyone on chronic or high-dose opioids.
Central California Alliance for Health
CCAH also supports and participates in the SafeRx Santa Cruz and Prescribe Safe Monterey MAT Advisory Group. The advisory group is a peer support and resource group of physicians, advanced practice clinicians, and behavioral health providers focused on improving recovery capacity and quality for those with opioid use disorder. It meets periodically in person and also pairs local mentors with providers who have, or are interested in obtaining, a buprenorphine waiver. It also offers a Google Group for case discussions and Q&As, and a Google Drive folder with training and prescribing resources.
Inland Empire Health Plan
Both BHI and MAT are evidence-based practices. During this pilot, there will be nine physicians newly providing medication-assisted treatment to approximately 500 IEHP members with opioid use disorder. There will be eight new behavioral health clinicians providing treatment to approximately 1,500 IEHP members with behavioral health conditions. A year after the grant ends, the number of IEHP members receiving medication-assisted treatment is expected to double to 1,000. The number receiving behavioral health services is expected to increase 70% to more than 2,500. Both the MAT and BHI pilots will improve health equity by providing care to populations that have been historically stigmatized and have suffered worse health outcomes. In addition to access to treatment, one of the pilot’s primary goals is to decrease bias and stigma held by health care team staff.
L.A. Care Health Plan
L.A. Care offers provider training in substance use disorders and supports buprenorphine trainings, allowing physicians to obtain waivers to prescribe buprenorphine in primary care and other settings.
Commercial and state-funded health plans contract with Workit Health to expand MAT access for their members. In California, Workit Health offers free care to uninsured and underinsured patients, supported by California’s hub-and-spoke program. The flexibility of telehealth allows Workit to take care of patients from distant or rural areas without the demands of continual in-person follow-up visits.
In Michigan, Workit Health contracts with Priority Health, a commercial insurance plan, through a hybrid claims-based and bundled billing model, demonstrating savings on inpatient treatment costs, emergency room visits, and high opioid use. Retention rates for those in the program average around 90%, which is unheard-of for many other types of addiction treatment.
- Addiction Treatment Starts Here: Primary Care: Learning collaborative and technical assistance for community clinics learning to integrate MAT.
- ED-Bridge: Guidelines, resources, and tools to support integration of buprenorphine treatment in emergency departments.
- MAT in County Criminal Justice Settings: Learning collaborative and technical assistance for jails to integrate MAT.
- Project SHOUT (Supporting Hospital Opioid Use Treatment): Guidelines, resources, and tools to support integration of buprenorphine and methadone treatment in hospital inpatient and surgical settings.
- UCSF Warmline: Free provider-to-provider consultation by addiction specialists, 6 AM–5 PM (PT) at 855.300.3595. Includes expertise on HIV and hepatitis prevention and treatment.
- Association for Community Affiliated Plans: Strategies to Increase MAT Prescribing
- P. Todd Korthuis et al.: “Primary Care–Based Models for the Treatment of Opioid Use Disorder“
- SAMHSA: Behavioral Health Treatment Services Locator
- University of New Mexico, UC Davis, and Weitzman Institute: Project ECHO