In response to the national opioid epidemic and the prevalence of other Substance Use Disorders (SUD) in the U.S., 30 health systems are coming together to expand access to treatment, confront the cultural stigma of addiction, and provide new solutions for their communities. Across the U.S., 23.4 million Americans are suffering from drug use disorder and substance use disorder.1 National leaders John Kasich, former Ohio governor, and former Congressman Patrick J. Kennedy, founder of The Kennedy Forum and former member of the Presidents Commission on Combating Drug Addiction and the Opioid Crisis, joined the health systems and a select group of payers to kick off this work, which marks the fourth area of focus for the Medicaid Transformation Project (MTP), a collaborative effort to transform healthcare and the related social needs for the nearly 75 million Americans who rely on Medicaid and other vulnerable populations. MTP first launched in August 2018 and since its inception has seen more than 100 projects initiated across 30 health systems to address community-based care, behavioral health, and maternal and infant health.
Communities face a mounting crisis:
- 70,237 drug overdose deaths occurred in the U.S. in 2017 and opioids contributed to 67.8% of all drug overdose deaths2
- As many as one in five Medicaid beneficiaries experiences SUD and/or a mental health condition, and this accounts for 46% of the total Medicaid spending on healthcare services3
- In 2017, an estimated 20.7 million people needed substance use treatment, but only about one in eight people in that group received treatment at a specialty facility4
- The U.S. spends around $35 billion across public and private payers to treat substance use disorder, though the annual costs associated with substance misuse and use disorder are estimated to be more than $400 billion5
The cultural stigma associated with addiction also poses a unique challenge as it hampers the healthcare industrys understanding of the issue and impedes patients access to effective treatment. Health systems in the Project are focusing on innovative care models and digital tools designed to improve the screening and diagnoses of substance use disorder in patients, and aid in the development of personalized care plans to engage patients in treatment.
Addiction isnt about character “ addiction is a chronic disease based on chemical reactions. For too long, weve stigmatized those suffering from addiction and, as a result, the healthcare industry has fallen short when it comes to providing effective, thorough, quality treatment, said Andy Slavitt, Chair for the Medicaid Transformation Project, former Acting Administrator of CMS and General Partner at Town Hall Ventures. The health systems in MTP are challenging the status quo. The time is now to not only change the dialogue, but to adopt innovative solutions and services to make real, lasting change when it comes to addiction treatment.
Acting with intention and innovation
The Substance Use Disorder Initiative launched in December with an Action Forum in Chicago, IL with over 100 leaders from many of the countrys most innovative health systems and national leaders, such as former Ohio Governor John Kasich and former Congressman Patrick J. Kennedy, founder of The Kennedy Forum and former member of the Presidents Commission on Combating Drug Addiction and the Opioid Crisis in attendance. The launch signifies the start of a multi-month effort to identify, select, implement, and scale solutions that transform the role health systems play in treatment and recovery.
For this Action Forum, MTP analyzed more than 130 solutions available in the substance use arena to create a shortlist of 12 digital solutions and care models that were then profiled at the Action Forum. These solutions are designed to support outpatient treatment expansion, prevention and early detection of substance use disorder, peer recovery services, telemedicine access to Medication-Assisted Treatment, and contingency management. Taken together, these solutions can support the nations strained treatment infrastructure and contribute to the development of an integrated treatment and recovery network.
The Projects rigorous solution selection methodology enables health systems to tailor decisions to their individual organizations needs, accelerate decision-making, and ultimately drive long-lasting results for their patients in a financially self-sustaining manner.
Health systems feel urgency to act not only because of the growing public health crisis, but also because there are pressing opportunities to fill treatment gaps, drive financial opportunities in both fee-for-service and value-based care environments, and unlock clinical and operational efficiencies by keeping patients engaged in treatment and reducing reliance on high-cost settings such as emergency departments.
Payers are also seeking to act and this Action Forum marked the first time that they were invited to formally participate in the Project. An exclusive morning session for provider-sponsored plans and third-party payers explored alternative payment models and state procurement trends for SUD and concluded with several solution demos.
Leading policy experts Vikki Wachino, former head of the Center for Medicaid and CHIP Services at CMS, and Molly Coye, former Commissioner of Health for the State of New Jersey and Director of the California Department of Health Services, as well as Slavitt, are directly involved in shaping this initiative and guiding its efforts.
Building on the Medicaid Transformation Projects success
Project Members are building off the successes of the previous three initiatives “ Community-Based Care, Behavioral Health, and Maternal and Infant Health “ and leveraging lessons learned to accelerate progress with the work related to the Substance Use Disorder Initiative.
Substance use disorder has been at the forefront of our minds, and the minds of our partners since we first launched the Medicaid Transformation Project. We knew this would be one of the most challenging areas to tackle, as addiction is a serious chronic illness that requires long-term treatment and support, said David Smith, Project Executive of MTP. The Projects model of collaboration gives health systems a unique opportunity to work together to identify, adapt, and scale solutions that will ultimately improve care access and treatment options for those suffering from addiction. We have already seen proof that this approach drives fast, real change and we anticipate similar results as health systems get further involved in the work on substance use.
About the Medicaid Transformation Project
The Medicaid Transformation Project is a national effort to transform healthcare and address related social needs for the most vulnerable. Health systems will implement innovative solutions that address challenges like behavioral health and substance use disorder. This will create long-term systemic impact with the goal of improving the health of 75 million Americans.
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1 Pain in the Nation: The Drug, Alcohol and Suicide Crises and the Need for a National Resilience Strategy. https://www.paininthenation.org/assets/pdfs/TFAH-2017-PainNationRpt.pdf. November 2017. 2Drug Overdose Deaths. Center for Disease Control and Prevention, National Center for Injury Prevention and Control. Accessed December 2019. https://www.cdc.gov/drugoverdose/data/statedeaths.html 3 Potential economic impact of integrated medical-behavioral healthcare: Updated projections for 2017. Milliman Research Report. Accessed December 2019: https://www.milliman.com/uploadedFiles/insight/2018/Potential-Economic-Impact-Integrated-Healthcare.pdf 4 Key Substance Use and Mental Health Indicators in the United States: Results from 2017 National Survey on Drug Use and Health. Substance Abuse and Mental Health Administration. Accessed December 2019. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHFFR2017/NSDUHFFR2017.pdf 5 Chapter 6. Health Care Systems and Substance Use Disorders. The Surgeon Generals Report on Alcohol, Drugs and Health. Accessed December 2019: https://addiction.surgeongeneral.gov/sites/default/files/chapter-6-health-care-systems.pdf
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