How Major Payers Provide Substance Abuse Care for Opioid Misuse

Since the Health and Human Services announced a national state of emergency regarding the opioid epidemic in 2017, the need to improve both initial responses and follow up substance abuse care practices is more pressing than ever.

Payers can play a pivotal role in promoting and modeling innovation, awareness, and outreach. Major payers are establishing their own programs, investing in innovative initiatives, and partnering with other stakeholders to improve their approach to substance abuse care for beneficiaries struggling with opioid misuse. Among the major payers focusing on substance abuse care improvements for opioid misuse are Aetna, Blue Cross Blue Shield (BCBS), and UnitedHealthcare. The three payers are demonstrating critical ways that payers can get involved with improving substance abuse recovery for their beneficiaries.

Aetna’s Guardian Angel program

Aetna’s Guardian Angel program specializes in persistently following up with members to help in the recovery process.

“Our data revealed that there were significant gaps in care for many members who had survived an overdose. We noticed patients would be treated in the ED and discharged with minimal ongoing support,” Daniel Knecht, MD, vice president of health strategy and innovation for Aetna, explained in a press release.

As part of its three-pronged substance abuse care approach to prevent, intervene, and support in cases of opioid addiction, Aetna connects survivors with trained clinicians who give both emotional and practical support. The staff work to build trust with the victims and inform them and, with permission, their families of resources and treatments that can help them out of their addiction.

As of June 4, 2019, the program has achieved a 50 percent engagement rate, supporting over 600 Aetna members.

“A key piece of our success, is the active outreach Angels do. Often, they make up to eight calls just to be able to connect with the member,” Jennifer Johnson, senior director of program management shared in the announcement.

Blue Cross Blue Shield North Carolina invests in local opioid care initiatives

Blue Cross NC announced in January that it awarded five grants to address the opioid epidemic in their state, where three people die from an opioid overdose every day. Blue Cross NC awarded a total of $2 million toward the selected projects, accounting for one-fifth of the $10 million the payer has dedicated to the opioid epidemic.

“Investments to address drivers of health lead to better health outcomes,” Patrick Conway, MD, President & CEO, Blue Cross Blue Shield North Carolina (Blue Cross NC) stated on the organization’s website.

Three of the recipients focus on providing long-term substance abuse care to survivors:

• The University of North Carolina at Chapel Hill School of Medicine will develop a program within its UNC Extension for Community Healthcare Outcomes for Rural Primary Care Medication Assisted Treatment (ECHO for MAT) initiative, called the Group Visit Project. The university will “integrate primary care, behavioral health, and group therapy into a combined program.”
• The Rowan County Health Department will be building a Post-Overdose Response Team (PORT), inspired by other PORTs across the nation. Between 2001 and 2016, the number of unintentional overdose deaths tripled in Rowan County. To end the epidemic, the county’s health department will form teams consisting of a harm reduction advocate, a certified peer support specialist, and a community paramedic from emergency medical services. The community paramedic is the first responder on the scene of the overdose. They will connect the survivor with their two team members who will consistently reach out to integrate the patient into a support group.
• The Pacific Institute for Research and Evaluation (PIRE) will be working in Stanly County, which has the highest rate of ED visits due to opioid overdose in North Carolina. PIRE will train medics on how to treat opioid overdoses on site and will follow up with survivors to enroll them in a Medication-Assisted Treatment program.

The other awardees included Duke University Health System’s Symmetry, an application for both patients and clinicians that informs patients about correct usage of the drug, tracks home opioid use, and predicts potential misuse patterns. Together for Resilient Youth (TRY) was the fifth recipient who will use the grant to roll out a recovery program for a broad demographic in seven counties.

UnitedHealthcare Community Plan of Tennessee collaborates with local stakeholders

In March, UnitedHealthcare Community Plan of Tennessee, the Tennessee Initiative for Perinatal Quality Care (TIPQC) at Vanderbilt University, and OptumLabs agreed to collaborate to provide support for a specific group of opium addiction survivors: newborns with neonatal abstinence syndrome.

“The primary focus of the initiative is to offer a supportive environment for obstetric and newborn care providers to share best practices for treating their patients with opioid exposure, collect and identify patterns of care and ultimately implement evidence-based protocols in a variety of clinical settings,” the press release explained.

Nationally, an infant experiences opioid withdrawal every 15 minutes. In 2018, healthcare providers saw 881 cases of NAS in Tennessee alone.

UHC, TIPQC, and OptumLabs are looking for ways to provide immediate substance abuse care to reduce the mortality rate and long-term effects of neonatal abstinence syndrome in the state.

The project emphasizes educating hospitals and birth centers so that infants can avoid being transferred to a NICU, which could result in complications and removes the mother and child from their local support system.

“We’re trying to streamline treatment for these infants for the entire state. If we can get everyone on board…hopefully we’ll get it to the point where we can treat it successfully and get the babies home sooner,” Brandy Eddlemon, director of Women’s Health and Pediatric Clinical Operations for the UnitedHealthcare Community Plan of Tennessee, stated in a press release.

June 17, 2019 - With new programs, investments, and collaboration with providers and healthcare organizations, Aetna, Blue Cross Blue Shield, and UnitedHealthcare demonstrate how payers can respond to opioid misuse with continued substance abuse care to the recovering survivors.