Despite some notable challenges in coordinating care for patients with a substance use disorder (SUD), some safety net plans are finding success by streamlining case management processes, focusing on social determinants of health and leveraging data.
So says a new analysis from the Association for Community Affiliated Plans (ACAP), an organization representing Medicaid managed care organizations (MCOs) and other safety-net health plans. The report analyzed four safety-net insurers: AmidaCare (N.Y.), Hennepin Health (Minn.), Health Plan of San Joaquin (Calif.), and CareSource (Ohio, Ky., Ind., Ga., and W.Va.).
Many patients with SUD are enrolled in Medicaid, including an estimated 40% of nonelderly adults with an opioid addiction, according to ACAP. Their care needs are complex—often requiring a mix of physical and behavioral health services—so their care can be fragmented and difficult to access.
By managing and coordinating care effectively, Medicaid managed care organizations can make “a major impact on the health, well-being, and life expectancy of those individuals.”
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Still, several policy barriers remain are have handcuffed plans dealing with SUDs, the report notes. 42 CFR Part 2, a federal privacy regulation, prevents providers from sharing information with one another about patients with SUDs—a fundamental aspect of care coordination.
Several organizations pushed for changes to that regulation in Congress' recent opioids bill, but the provision was ultimately left on the cutting room floor.
Nevertheless, standardizing consent forms and incentivizing providers to obtain patient consent could make this easier until that policy is changed, the analysis suggested.
To make matters more complicated, misconceptions about federal and state privacy regulations among providers are common, and providers often do not trust one another. ACAP recommends that plans offer providers clear guidance on privacy regulations and lead meetings between providers to facilitate collaboration.
Despite these challenges, there is room for plans to make significant strides.
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For instance, insurers can bolster their healthcare workforce by training existing care partners in integrated care, as well as SUD-specific interventions like medication-assisted therapy (MAT). They can also engage with social service agencies and paraprofessionals, such as community health workers and recovery coaches.
Plans should also work within the context of the communities they serve by involving regionally based, culturally competent workers. In conjunction with providers and other agencies, they can also reach out to patients directly, including with information about nonmedical benefits.
Patients can be reached through a variety of methods, from referrals to databases. The report said data could also be used to monitor patients’ needs and the quality of their care, as well as to facilitate the care they receive.