Medicaid Managed Care Providers Experiment with Expanding Access to Behavioral Health, Substance Use Treatment

July 2, 2019
New Commonwealth Fund report highlights efforts to use technology to make services more convenient, customized and responsive to beneficiaries

At Healthcare Innovation, we have written many articles over the past few years about efforts to use digital technology to help address the opioid epidemic and to increase access to behavioral health providers, particularly for Medicaid patients and patients in rural areas where there are provider shortages.

For instance, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) has supported programs that address the potential connection between telehealth and the opioid crisis in rural America. The federal Health Resources and Services Administration’s (HRSA) Office of Rural Health Policy has given grants to organizations to establish a Substance Abuse Treatment Telehealth Network.

“Substance abuse treatment is an excellent use of telehealth,” said William England, director of HRSA’s Office for the Advancement of Telehealth. Particularly relevant in addiction treatment is the convenience factor for patients who otherwise would travel long distances to see a provider. And telehealth can enable them to get the care that they might otherwise skip, he says, helping to reduce relapse rates.

In another example, the Agency for Healthcare Research and Quality (AHRQ) has invested $9 million over three years in an initiative to improve opioid addiction treatment in rural primary care practices, including the use of telemedicine. The grants are supporting primary care practices in 75 rural counties in Oklahoma, Colorado and Pennsylvania and includes the use of Project ECHO, an effort that links community providers with specialist care teams at academic medical centers, or other forms of teleconsultation. The initiative is bringing together teams of state health departments, academic health centers, researchers, local community organizations, physicians, nurses, and patients to bring Medication-Assisted Treatment (MAT) to primary care practices in rural counties in Oklahoma, Colorado and Pennsylvania.

Now comes a new and valuable report from the Commonwealth Fund, written by Martha Hostetter and Sarah Klein, that highlights how Medicaid managed care companies are turning to technology to make services more convenient, customized, and responsive to beneficiaries with mental illnesses and substance abuse disorders.

Setting the scene, the report notes that about one of five Medicaid beneficiaries has a behavioral health diagnosis, but this group accounts for nearly half of all Medicaid spending. Even with the Medicaid expansion in many states, people struggle to find treatment because of shortages of behavioral health clinicians who accept Medicaid reimbursement, particularly in rural areas.

In the challenging area of expanding access to medication-assisted treatment (MAT), the report highlights to efforts of Boulder Care, which is partnering with pharmacies to deliver buprenorphine (one of the medications used to treat opioid use disorder) to people’s homes and using chat and video messaging to provide support. The report notes that Boulder Care’s model is now being piloted in New Hampshire and Oregon, with clinicians seeing patients once before they begin using the virtual platform.

In the realm of closing the loop on referrals, the report points to examples of technology companies that are trying to streamline behavioral health referrals by making it easier to assess patients’ needs and identify available and appropriate programs. “One platform, OpenBeds,  focuses on behavioral health referrals and coordination; it was founded by Nishi Rawat, M.D., who as a critical care physician in a small Baltimore hospital struggled to find treatment slots for patients with behavioral health problems.”

OpenBeds offers decision support tools to help clinicians as well as case managers assess patients’ acuity and particular needs. The system generates a list of recommended facilities; users can make digital referrals and receive responses from the facilities. They can also use the platform to track whether patients are engaged in treatment. Delaware and Indiana have implemented the platform statewide; four other states are in the process of doing so.

The Commonwealth Fund report identifies another group of companies offering  therapy, education, and coaching delivered via algorithm-driven programs that complement or serve as alternatives to traditional talk therapy. One is myStrength, part of the Livongo company, which the report notes is being used by Medicaid managed care plans to engage members who appear to have unmet behavioral health needs. “First-time users answer a series of questions about their well-being, social supports, and life experiences and are then directed to a suite of interactive resources based on cognitive behavioral therapy, motivational interviewing, mindfulness, and other evidence-based counseling approaches. Someone coping with depression, for example, may be guided through strategies to help them feel better, while someone with anxiety may be offered tools to reduce panic and prevent future instances when they feel out of control.”

Finally, the report notes that organizations such as the Center for Care Innovations and HealthTech4Medicaid are working to call attention to market opportunities and promote collaboration among developers, states, health plans, and patient advisory panels.

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