AMA-Led Alternative Payment Model Aims to Improve Opioid Use Disorder

April 19, 2018
The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) have jointly announced the release of a concept paper detailing an alternative payment model (APM) that will aim to improve how patients with opioid use disorder are treated.

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) have jointly announced the release of a concept paper detailing an alternative payment model (APM) that will aim to improve how patients with opioid use disorder are treated.

The new payment model, called Patient-Centered Opioid Addiction Treatment (P-COAT), is expected to increase the number of patients with opioid use disorder who are able to lead satisfying, productive lives through successful management of their condition while also reducing healthcare spending on costs associated with addiction, such as emergency department visits and hospitalizations, according to officials from the associations.

The new payment model specifically seeks to increase utilization of and access to medications for the treatment of opioid use disorder by providing the appropriate financial support to successfully treat patients and broaden the coordinated delivery of medical, psychological, and social support services.

P-COAT is also designed to support office-based opioid treatment in order to facilitate coordination between multiple treatment providers. Previously, payment for these services has been segregated, which contributes to patient difficulties receiving comprehensive care, officials noted.

The P-COAT APM is based on research which shows that medications combined with psychosocial supports is effective in treating individuals with opioid use disorder. But unfortunately, according to the associations, “The current physician payment system offers little support for the coordination of behavioral, social and other support services that patients being treated for opioid use disorder need in addition to their medication. Non-face-to-face services—such as phone calls and email consultations with patients—in addition to better coordination between specialists, outpatient treatment programs and other health providers such as emergency rooms, are essential to the delivery of effective, evidence-based treatment to the individuals who need it.”

ASAM and the AMA are now seeking physician practices and insurers interested in pilot testing the new payment model. Anyone interested in participating in P-COAT should submit their contact information here.

“The current physician reimbursement structure does not account for all the services that patients with an opioid use disorder need to progress to successful treatment and recovery,” noted Shawn Ryan, M.D., chair of the AMA-ASAM APM Working Group and ASAM’s Payer Relations Committee. “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. We hope that today’s announcement will begin a national conversation with insurers and policymakers about what it takes for successful treatment and recovery.”

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