Dive Brief:
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The American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM) are coming together with a new payment model that aims to tackle the opioid epidemic.
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The two groups have released a concept paper for an alternative payment model (APM) called the Patient-Centered Opioid Addiction Treatment (P-COAT) model.
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P-COAT seeks to increase utilization and access to medications for treating opioid use disorder. The model does this through “providing the appropriate financial support to successfully treat patients and broaden the coordinated delivery of medical, psychological and social support services.”
Dive Insight:
Payers, providers and policymakers are all working to combat the opioid epidemic. Payers have implemented policies and goals that seek to reduce opioid prescriptions and abuse. Providers are writing fewer opioid prescriptions, working with community groups and using social determinants of health (SDoH) data to find at-risk people before they become addicted to opioids.
Payers and providers have effectively reduced opioid prescriptions over the past decade, but addiction and overdose costs have gotten worse. In fact, inpatient and outpatient treatment for opioid addiction and overdose added $26 per person to the annual cost of health benefits coverage for large employers in 2016. That’s an increase from only $3 in 2004.
These numbers show stakeholders need an additional approach. The ASAM and AMA seek to solve another piece of the problem — provider reimbursement. The groups are now seeking physician practices and payers interested in testing the new payment model.
They said P-COAT will improve care coordination, as the current system segregates payment for the services. This leads to “patient difficulties receiving comprehensive care.” Instead, P-COAT looks to support office-based opioid treatment that facilitates coordination between multiple providers.
The groups said the new model can improve patient health while reducing healthcare costs, specifically cutting down on costs associated with emergency department visits and hospitalizations.
Shawn Ryan, chair of the AMA-ASAM APM Working Group and ASAM’s payer relations committee, said the current physician reimbursement structure doesn't account for services needed to help patients with an opioid use disorder. P-COAT, on the other hand, will recognize non-face-to-face services, including phone calls and email consultations with patients.
Ryan said he hopes the new APM will start a national discussion about what’s needed. “While we know that a combination of medication and psychosocial support systems is the evidence-based standard for treatment, we continue to find that patients are not able to access treatment due to limited or non-existent insurance coverage,” he said.