Opioid Use Disorder (OUD) Recovery Support Program

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Introduction


Since 2011, MAP Care Solutions has conducted over 200,000 peer-led engagements for substance use disorders inclusive of over 3,000 individual cases related to Opioid Use Disorder.

MAP Care Solutions utilizes tech-enabled, peer-led care management to provide long-term support for members and their family in order to identify recidivism and facilitate earlier intervention. By improving and maintaining engagement with these populations over time, MAP is able to reduce utilization costs, improve network retention and most importantly provide the chronic disease support necessary to help individuals achieve and sustain long-term recovery.

The Opioid Epidemic's Cost


Over the last 10 years our nation has seen an unprecedented rise in opioid use and abuse. The Centers for Disease Control estimates that in 2016, 175 people died every day from a drug overdose.1 Current estimates are that over 500,000 lives have been lost due to the opioid epidemic and trends point to worsening with the increase in the use of heroin and fentanyl laced products. For every one life lost it is estimated that there are at least 42 individuals with an active opioid use disorder, with only 10% receiving specialty treatment for their condition.2 Between 2011-2015, costs related to opioid use disorders have increased 1000-fold for insurers with payments in excess of $446 million dollars in 2015.3

Program Overview


  • MAP's OUD recovery support program is led by certified peer recovery support specialists and other licensed behavioral health professionals with the primary function of promoting adherence to recovery plans and identifying subsequent care needs through long-term and frequent engagement
  • Recovery support services include: non-clinical peer support via telehealth or face-to-face sessions, family support sessions, behavioral health assessments, in-network care coordination and referrals for medical, psychiatric and counseling services
  • MAP Care Solutions team works with the payer and member’s attributed primary care provider to match members with Medication Assisted Treatment (MAT) providers and in-network treatment programs for detoxification, intensive outpatient, partial hospital or residential care as appropriate
  • MAP also provides face-to-face peer support through community based chapters in 22 states with monthly chapter meetings, regular recovery meetings (including peer support and local community support with housing, education, transportation and life skills)
  • MAP will conduct periodic behavioral health assessments and coordinate appropriate behavioral health and primary care services in-network
  • Adaptive engagement options to enhance peer support include mobile apps, passive messaging, and remote monitoring technology such as breathalyzers, med adherence devices, and apps.

Referral Sources from Payers and Providers


MAP Care Solutions collaborates with payers and providers to provide members and family supports with comprehensive peer-led recovery support upon referral from the following sources:

  • Utilization management team
  • Disease state care management team
  • Both in and out of network treatment center referral
  • Medical referral sources (e.g., Emergency Room, OB-GYN, and Primary Care)
  • Internally generated: Data analytics from medical/BH claims and pharmacy data identifying potential Opioid Use Disorder

Value to Payers and Risk Bearing Entities:


Implement Opioid Addiction Recovery Support and Member engagement programs to improve outcomes and reduce costs

  • Reduce the impacts of relapse such as readmissions and admissions into high cost levels of care (acute treatment, ER, etc.)
  • Facilitate referral for Medication Assisted Therapy (MAT)
  • Improve post-discharge engagement with members and simultaneously engage family and other primary supports
  • Target highest risk, high-utilizing members for maximum impact potential
  • Reduce OON leakage – Improved care coordination keeps members “on the grid” and in network for Payers

Use real-time data and alerts to deliver optimal care coordination and member satisfaction

  • Centralize OUD focused care coordination and case management for operational and administrative efficiencies
  • Identify and stratify risk of OUD among members to provide the appropriate level of engagement and support based on ongoing assessment of risk level
  • Support lower cost of care delivery models via telehealth and face-to-face community chapter based counseling sessions

Improve collaboration with providers in tackling OUD

  • Work with payer’s care management team to proactively manage relapse
  • Establish preventative care models with primary care and psychiatrist involvement in screening members
  • Further differentiate the payer brand with providers by extending care continuum post-treatment

Collect actionable outcomes data for Members and measure provider performance

  • Understand prescribing patterns for attributed primary care and behavioral health providers
  • Collect standardized outcomes data and analyze “quality” across behavioral health and primary care providers as well as treatment centers aligned to the payer’s network
  • Integrate claims and clinical data with MAP outcomes data for measuring cost savings, utilization and outcomes for members in opioid focused programs
  • Prepare SUD and BH provider for the paradigm shift to value-based reimbursement to help address one of the biggest health issues facing our nation

Citations


  1. “CDC Monthly Drug Overdose Death Estimates” https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdf
  2. “Commission on Combating Drug Addiction and the Opioid Crisis Interim Report” https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf
  3. “The Opioid Crisis: Impact on Healthcare Services and Costs” https://goo.gl/EZ9zcf