AMA report: Insurers should follow Medicaid's lead in mitigating opioid epidemic 

Health insurers looking to do more to address the opioid epidemic should look to what’s working in Medicaid, according to a new report from the American Medical Association (AMA) and consulting firm Manatt Health. 

The two organizations joined forces to release a new national road map that examines state-level efforts to tackle the opioid crisis. 

One of the key themes that emerged from the research—which focused in four states: Colorado, Mississippi, North Carolina and Pennsylvania—is that Medicaid is more consistently ahead of the curve in providing the services patients need to deal with substance abuse disorder. 

Joel Ario, managing director at Manatt Health Strategies and former insurance commissioner in Pennsylvania and Oregon, said during a briefing with reporters Monday that it’s not uncommon for state insurance regulators to look at what’s working in Medicaid and pushing payers to try those ideas. 

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In states with private, Medicaid managed care programs, the payers may already have experience with covering medication-assisted treatment and other services, he said. 

“I do think our broader message is this is not just a public programs issue,” Ario said. “It is also an issue for the private insurance companies.” 

Based on its evaluation of the four states, two of which expanded Medicaid under the Affordable Care Act, the AMA and Manatt identified six key action areas for policymakers and regulators: 

  1. Ease barriers such as prior authorization to medication-assisted treatment, and ensure it’s affordable. 

  1. Enforce mental health and substance use disorder parity laws. 

  1. Examine network adequacy to ensure people have access to behavioral health professionals and take steps to enhance and support the opioid treatment workforce. 

  1. Provide comprehensive and multidisciplinary pain care—including opioids when clinically appropriate and equitable access to alternatives. 

  1. Grow access to naloxone. 

  1. Establish a process for evaluating what policies are working, and which aren’t, to address opioid addiction. 

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The researchers noted that the ongoing evaluation would include continued study and monitoring of programs launched under federal grant programs. Though Congress has mandated billions in federal funding to assist in opioid addiction programs, state health officials say there are major drawbacks. 

For one, while these grants are beneficial in the near term, it’s not an effective strategy for planning a long-term approach, said Susan Kansagra, M.D., chronic disease and injury section chief at the North Carolina Department of Health and Human Services, at the briefing. 

For example, the health department could provide money to a physician group to hire additional personnel for substance abuse treatment, but can only guarantee that money for one or two years, making it hard to sustain employment for those clinicians, she said. 

North Carolina did not expand Medicaid, so an additional challenge is using federal funds to help mitigate the costs associated with treating uninsured people with drug addiction, Kansagra said. The report emphasizes Medicaid expansion as a key tool for addressing opioid addiction.

“There’s a huge population of uninsured [people] that are receiving treatment through these funds, and that requires many years, if not a lifetime, of treatment recovery support,” she said.