Citing “arbitrary limitations” on treatment of opioid use disorder, the American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) have released a proposal for an alternative payment model. The associations say the Patient-Centered Opioid Addiction Treatment (P-COAT) model would provide appropriate reimbursement and broaden care coordination, particularly for medication-assisted treatment (MAT).
“Unfortunately, in the United States today, treatment for opioid use disorder may or may not include medication-assisted treatment or psychosocial interventions, including therapy and social supports. That should not be the case,” says Shawn Ryan, MD, MBA, ABEM, FASAM, chair of the payment model working group and ASAM’s Payer Relations Committee. “We’re trying to help to consistently define treatment as biopsychosocial interventions, which means medication-assisted treatment plus psychosocial interventions.”
Providers of medication for OUD treatment would be eligible to receive payments for both the initiation and maintenance of medication-assisted treatment. The one-time initiation payment would support evaluation, diagnosis and treatment planning for a patient, as well as the first month of outpatient MAT treatment. Ongoing monthly maintenance payments would cover the costs of coordination or provision of outpatient medication and support services, continuing as long as treatment is deemed appropriate for the patient.
In both the initiation and maintenance phases, patients would be expected to receive buprenorphine or naltrexone in an office-based outpatient program, as well as outpatient psychological and/or counseling therapy, and coordination of other supporting services.
Existing payment models used by commercial insurers, Medicare and Medicaid segregate payment for medical, psychological and social support services. But the P-COAT model would coordinate all aspects of care and facilitate coordination between multiple care providers as needed. ASAM and AMA believe the model would reduce or eliminate spending on high-cost treatments that have been ineffective and inefficient.
“If you’re in an office where you have the full suite of medical, psychological and social staff, that’s great,” Ryan says. “If you are a site that does medical only but can coordinate with psychosocial supports, that’s fine also. This supports either of those. It really wants to drive that coordinated care that we know makes a difference in patients’ recovery.”
ASAM and AMA currently are seeking physician practices and insurers interested in pilot testing the P-COAT alternative payment model. The full payment model can be viewed on the ASAM website.