Backed by medical groups, value-based payments for opioid addiction treatment could be imminent

Hydrocodone opioid pills
Two medical associations are pushing for greater use of value-based payments in opioid addiction treatment. (Getty/smartstock)

Two medical associations have announced a collaborative value-based payment model for opioid addiction treatment, amid discussions in Congress on how to manage the crisis. 

The payment model (PDF), announced by the American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA), is aimed at improving care coordination and lowering healthcare spending by reducing costly emergency department visits and hospitalizations, which are common for people with addiction. The model increases utilization of and access to medications for opioid treatment, combining them with the appropriate level of medical, psychological and social support services which can be delivered at multiple providers, similar to an ACO.

The organizations said medication-assisted treatment is currently underutilized due to limited insurance coverage, a shortage of qualified physicians and a lack of access to addiction specialists for many patients. 

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The groups added that barriers exist even for patients who are covered for the services, such as prior authorizations, limited telehealth coverage, and transportation and billing complications. 

"It is intended to deliver better, individualized treatment to the patient in proportion to their needs," Shawn Ryan, M.D., chair of ASAM’s Payer Relations Committee, told FierceHealthcare. "The model is for outpatient care only. Residential and inpatient treatment have no increased long-term benefits compared to outpatient treatment."

The groups are currently seeking physicians and insurers to join in a pilot for the payment model, but a basic version of the model is already in operation with Optum, according to Ryan, who said the payer might opt in to transitioning to the new model.

Ryan added the groups have discussed the model with officials at the Centers for Medicare & Medicaid Services, as well as its innovation center, which is responsible for new demonstration programs.

At the same time, Congress continues to debate in both chambers how to best address the crisis on a national level.

Yesterday, a bipartisan group of Senators announced the "Opioid Crisis Response Act of 2018" which came to fruition after seven congressional hearings on the matter. Markup of the bill, which includes grants and increased funding for research and treatment, is scheduled for April 24. 

"The work isn’t over, and I look forward to more bipartisan progress in support of those we’ve heard from over the last several months, who are on the frontlines of the opioid crisis and are looking to Congress for support.," ranking member Sen. Patty Murray said in a statement. 

Additionally, leaders of the House Ways and Means Committee released a white paper last week outlining feedback from payers, providers and pharmacists about the best approaches to combating the opioid epidemic (PDF). Many respondents laid some blame on Medicare's current reimbursement structure as a driver of opioid overprescribing.