Best Practices in Managed Substance Use Disorder Treatment
In the United States, an estimated 22 million people live with a substance use disorder. Despite their prevalence, substance use disorders continue to go untreated: many individuals forgo help for addiction because of the surrounding stigma, while providers often lack the training to properly recognize and diagnose them. Even with a diagnosis, individuals still face fragmented treatment for these chronic conditions and a high rate of relapse. Without the proper supports, recovery can often seem impossible.
At Beacon Health Options (Beacon), recovery from substance use is not only possible—it’s expected. As today’s leading partner for helping people live healthier, more productive lives, Beacon provides superior clinical management for mental health and substance use disorders, a strong employee assistance program, specialty programs for autism and depression, and data- driven analytics to improve the delivery of care.
With more than 30 years of experience in managed care, we understand the unique challenges of addiction. Managing effective, evidence-based programs nationally and across all lines of business, we provide the right tools and resources to identify and treat substance use disorders and help individuals achieve and sustain long-term recovery. Beacon’s proven model of substance use disorder care management relies on seven core features:
1. Development and Management of a High Quality Continuum of Care
We maintain a continuum of care to ensure members receive the right kind of support and setting for the fluctuating intensity of their needs. Our national network spans every state and encompasses all levels of care, from inpatient detoxi cation programs to intensive outpatient rehabilitation and community-based support services, so members can move to a less restrictive setting as soon as their condition improves while remaining in a safe and therapeutic environment. Ultimately, our goal is to transition members into localized settings to access community-based care, support and resources and prevent unnecessary hospitalization.
We maintain strong partnerships with the substance use disorder provider community along the continuum of care. For example, we pay an enhanced rate for Structured Outpatient Addiction Program (SOAP) providers who use Motivational Interviewing or have an af liation with a homeless shelter. Our staff are also often recruited from the provider community—coming from a diverse array of programs and treatment backgrounds, including acute, residential, and outpatient levels of care—and help to ensure positive connections with the substance use disorder provider community across the entire service continuum.
2. Standardization of Screenings and Assessments
Despite their prevalence, substance use disorders frequently go undiagnosed and untreated. This can largely be attributed to individuals’ reluctance to seek help for these conditions due to the surrounding stigma of addiction, as well as a lack of provider training to properly recognize and diagnose these conditions. To help promote earlier engagement and improved outcomes for members, we use empirically validated screening tools to target substance use disorders when they are more manageable. And with more than a third of all mental health care in the U.S. now being performed by primary care doctors, we ensure these tools are readily available to providers in primary and community-based settings.
One of the ways we help medical providers identify individuals who may be at risk for developing a substance use disorder is through Screening, Brief Intervention and Referral to Treatment (SBIRT), a screening tool speci cally designed to target the larger population exhibiting harmful behaviors but not clinically substance-dependent. After undergoing a universal screening, individuals at risk for developing a substance use disorder receive an educational intervention to change their behavior, and, if appropriate, a referral for more extensive assessment or treatment. And because of its standardized provider training and screening guidelines, SBIRT can be administered in nearly every type of health care setting, including primary care, dental of ces, community health centers, and HIV clinics.
3. Endorsement of Uniform Medical Necessity Criteria
To ensure that treatment is effectively managed and that members receive the appropriate level of care, Beacon uses evidence-based medical necessity criteria, which guides decisions around service intensity, treatment setting, need for continuing care, and readiness for discharge. Beacon’s medical necessity criteria for treating substance disorders is based on the ASAM Criteria, a collection of clinical guidelines developed by the American Society of Addiction Medicine (ASAM) and the most widely used set of criteria in the United States for the treatment of substance use issues. The ASAM criteria takes into consideration the comprehensive needs of the member, including strengths, challenges, goals, and life areas. These objective standards establish a spectrum of services which members can move between based on their changing clinical needs, while also identifying the least intensive treatment services a member needs to recover.
The ASAM criteria individualizes treatment times so that members are not limited to a xed number of treatment days. By tailoring our medical necessity criteria to this multi-dimensional approach, Beacon can reunify the system of care, and connect members to the right services at the right time while meeting their unique and comprehensive needs. And to ensure we remain consistent with current clinical best practice, Beacon’s Corporate Executive Medical Management Committee and Company Quality Control review our medical necessity criteria at least annually.
4. Promotion and Adoption of Evidence-Based Services
To produce better outcomes for the treatment of substance use disorders, we promote systematic, evidence-based services developed by established experts in the eld. These programs include:
- Medication-Assisted Treatment (MAT): As the nation’s opioid crisis continues to grow, Beacon promotes the use of supervised medication in combination with counseling and behavioral therapies to treat the whole person. Beacon’s approach includes real-time support for prescribers, such as an expert staffed support hotline for those treating substance use disorders. By improving access to resources for medication self- management, we can connect more people to the help they need to recover.
- Structured Outpatient Addiction Program (SOAP): In Massachusetts, we incorporate SOAPs—short-term, structured, clinically intensive group-oriented treatment services— to individuals returning to the community from medically managed detoxification or acute treatment programs, or to individuals needing more intensive treatment than other outpatient programs may provide. We also endorse programs supported by Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence Based Programs and Practices, including:
- Matrix Model: Developed through 20 years of experience in real-world treatment settings, the Matrix Model is an intensive, 16-week outpatient treatment approach consisting of relapse-prevention groups, education groups, social-support groups, individual counseling, and urine and breath testing. The program is guided by a therapist, and includes education for loved ones affected by substance use disorders.
- Motivational Interviewing: We implement focused and goal-oriented Motivational Interviewing (MI) to help people recognize and change their high-risk behavior, and based on the individual’s goals, develop an action plan. Through incorporating MI counseling into their initial intake/orientation session, community-based substance abuse treatment clinics can also improve program retention.
- Wellness Recovery Action Plan (WRAP): A self-management intervention, WRAP teaches participants how to implement the key concepts of recovery into their everyday lives, and helps them identify their personalized wellness resources in order to make an individualized plan to manage their disorder.
5. Easing the Administrative Burden
To help providers take the focus off of cumbersome administrative tasks and enhance member experience, we offer easy-to-use online assessments, medical necessity determinations, authorizations, and claiming at no cost to the provider. Our streamlined system makes routine tasks such as processing claims, obtaining claims information, and verifying eligibility status easy and convenient. Providers may also receive quick technical assistance by contacting our Help Desk.
We also offer webinars on a quarterly basis for providers and their key staff to learn more information on our various system enhancements, as well as program and administrative updates.
6. Support for Recovery through Peer Services and Long-Term Chronic Care Management
Beacon understands that treating substance use disorders is a continuous process—in fact, the National Institute on Drug Abuse (NIDA) reports that the relapse rate for drug addiction is 40 to 60 percent. Because we recognize the challenges associated with substance relapse, we offer long-term support for substance use disorders based on the principles of recovery and resiliency as we work to return people to their communities.
Beacon’s Peer Services offer members collaborative support through persons who have lived with substance use disorders and reached a significant level of recovery. Our trained Peer Support Specialists offer ongoing assistance and education as members reintegrate back into the community, helping members learn problem-solving skills and other strategies to help them achieve and sustain recovery. Peer Support Specialists can also help members identify and connect with community-based resources to support their unique ongoing needs.
LONG-TERM CHRONIC CARE MANAGEMENT
Our chronic care management addresses the comprehensive needs of members with substance use conditions and helps them transition back into the community by addressing their holistic needs. Our approach promotes the integration of physical and behavioral health services at every key stage of service and improves overall integration and coordination of medical, behavioral, and psychosocial supports. We will work with medical case managers to ensure the development of culturally-specific, individualized care plans that reflect the member’s strengths and self- identified goals. We help members obtain services and connect them with community-based resources while advocating for the member’s needs, desires, and rights.
We endorse a chronic care model that provides an evidence-based framework to increase the quality of care, reduce costs and improve outcomes for individuals with substance use disorders.
This model incorporates the necessary societal, systemic, and legislative overhaul to promote continuous and real improvements in care and clinical outcomes, and has been successfully employed to treat individuals with various common chronic illnesses, such as diabetes.
7. Continuous Outcome Based Program Improvement
We continually measure and improve our substance use disorder programs by using SAMHSA’s National Outcome Measures (NOMs) performance targets that measures real-life progress for members undergoing addiction treatment. Measurements includes targets such as abstinence from drugs, abstinence from alcohol, and member social connectedness. Beacon also uses health risk assessments, surveys, and call/outreach statistics to continually inform and improve the care management program.
Putting Our Best Practices to Work: Beacon’s National Substance Use Disorder Program Experience
Since 2007, we have administered substance use disorder treatment services for non-Medicaid members funded by Kansas’ Substance Abuse Prevention and Treatment (SAPT) block grants. Overseeing integration of both state and federal funds for substance use treatment for adolescents, adults and families, we coordinate a complete and effective network of private and community-based substance use disorder treatment services.
Since 2009, we have also administered the Kansas Driving Under the Influence (DUI) program, a jail diversion program where non-violent offenders who have been convicted of their third or subsequent DUI charge receive medically necessary substance use disorder treatment.
Our substance use disorder program operates on the Recovery-Oriented System of Care (ROSC) approach to substance use disorder treatment and services, supporting a person-centered approach to recovery. Through our ROSC initiative, we improved member outcomes through a variety of services and programs, including:
- Person-centered case management
- Peer recovery services, including development of curriculum for potential peer staff
- Transportation services to help obtain wraparound services
- Overnight boarding services for women with children
- Encouraging providers to utilize recovery-oriented services such as Crisis Intervention and Alcoholics Anonymous meetings
To ensure that individuals have immediate access to appropriate treatment, we operate a 24/7 toll-free hotline for immediate support for screening and referral for substance use concerns. We also developed and conducted a pilot project for Medication Assisted Treatment, negotiating a reduced cost for Vivitrol to distribute medications across the state, and recruited and contracted with several labs to provide the required initial and periodic laboratory and biometric testing.
From 2008 to 2015, we achieved significant results and cost savings:
- Doubled the number of individuals gaining access to substance use disorder treatment while experiencing annual reductions in funding
- Decreased overall higher level of care average length of stay by almost 16%:
- Reintegration: 12% reduction in ALOS
- Intermediate Adolescent: 25% reduction in ALOS
- Social Detox: 30% reduction in ALOS
- Cumulative improvement in NOMS for 2015:
- Increased members’ social connectedness to their home environment: 1,595%
- Abstinence from drugs: 998%
- Abstinence from alcohol: 965%
For 15 years, Value Behavioral Health of Pennsylvania, a Beacon Health Options company, has managed substance use disorder services for HealthChoices, Pennsylvania’s county-based Medicaid program. Our substance use and support services make a significant impact in these counties, where low income and rural environments limits access to services for many citizens.
We serve each of our Pennsylvania clients individually, designing responsive, unique programs to meet the specific needs of each county’s staff, members, individuals in recovery, families and providers. Here are some of the services we provide:
- Our Intensive Care Managers specialize in coordinating care for members with complex substance use conditions, emphasizing care coordination with the member’s Physical Health MCO, with the goal of decreasing consumer hospitalizations and increasing community tenure.
- Our Peer Specialists and Drug & Alcohol Recovery Specialists provide critical education and problem-solving skills, helping members transition back into the community.
- We provide training to law enforcement, teachers, and juvenile justice works to recognize the signs and symptoms of substance use disorders, as well as referral protocols.
- Due to a high and growing rate of opiate and heroin use, we work with counties to evaluate the provider network to support the work of PCPs, and encourage the use of community support programs (i.e., recovery coaching, peer support, housing, and employment support) to ensure a chronic care model is readily available.
- Overall 96% satisfaction of consumers and families with services they received
- In Greene County, the percent of HealthChoices members who have used mental health and/or substance abuse services has increased by more than 61 percent from 2003 through 2012
As the administrative services organization (ASO) for the Maryland Department of Health and Mental Hygiene/Mental Hygiene Administration, we deliver cost effective, recovery-oriented care for 1.1 million Medicaid and eligible uninsured consumers.
To drive engagement, our community-based staff partners with providers and community support programs where our members live, and we offer PCP training and practice supports through:
- Screening, Brief Intervention and Referral to Treatment (SBIRT)
- Promoting Early Detection and Screening of Alcohol Used by Youths
- Alcohol Prevention and Screening During Pregnancy
To ensure services are accessible, we offer community health works and lay health educators of specific cultural backgrounds to provide a “cultural bridge.” Our eld-based Care Managers are continually in the community to engage individuals face-to-face, and we assist with any transportation barriers (such as providing Metro cards) and provide translation services when needed.
We are committed to a person-centered, recovery-oriented approach that actively involves individuals with lived substance use disorder experience, and employ Peer Specialists as well as contract with local peer-run agencies. Our Peer Specialists have worked with over 1,200 members.
- Increased the number of people served while decreasing the average cost per member
- Aligned cost of care with best practices, resulting in an annualized savings of $4.1 million
- Consumers reported 94% satisfaction rating with care management staff
Since 1996, Massachusetts Behavioral Health Partnership (MBHP), a Beacon Health Options company, has maintained a comprehensive community- based provider network offering a full continuum of acute and post-acute substance use treatment services across the Commonwealth. We currently have contracts with the entire substance use disorder treatment provider community serving the Medicaid population.
Using a Central Navigation System (CNS), we provide information and support for members seeking information about substance use treatment, and help them take full advantage of their substance use bene ts, as well as connect them to community-based services and groups that provide added support. Our team is focused on ensuring individuals receive services in the most appropriate setting to increase engagement in the recovery process. Some of these services include:
- Intensive Care Coordination
- Emergency Services Program/Mobile Crisis Intervention (ESP/MCI)
- Outpatient Substance Use Disorder Services
- Ambulatory Detoxi cation
- Acupuncture Treatment
- Diversionary Services
- Acute Treatment Services (ATS) for Substance Use Disorders
- Enhanced Acute Treatment Services (E-ATS) for Individuals with Co-occurring Mental Health and Substance Use Disorders
- Clinical Stabilization Services (CSS) for Substance Use Disorders
- Inpatient Substance Use Disorder Services (Level IV Detoxification Services)
Focus on Opioid Treatment and Prevention
Opioid addiction is an urgent problem in the Commonwealth that involves multiple systemic issues and requires effective long-term solutions in addiction treatment and psychosocial rehabilitation. We are executing a wide range of pilots and programs in Massachusetts to address the rising opioid epidemic. They include:
- The Changing Pathways project, which helps improve member transitions from inpatient withdrawal management programs to outpatient Medication-Assisted Treatment (MAT).
- Community Support Programs to promote adherence to MAT, ensure care continuity for members discharged from withdrawal management programs, and improve follow up appointment rates.
- Intensive Care Management for Methadone Maintenance program where Beacon partners with methadone treatment providers and leverages intensive case management to help improve methadone maintenance adherence. Improved adherence has been shown to reduce inpatient readmissions and mortality for these members.