Horizon Joins Coalition for National Standards for Substance Abuse

Lilo H. Stainton | November 9, 2017 | Health Care
Goal of ‘payers’ group is to make certain that addiction is ultimately treated like other chronic diseases

recovering drug addict
New Jersey’s largest insurance company has joined other healthcare payers from across the country to support evidence-based national standards for addiction treatment, a move the group called an early and important step to ensuring substance abuse is addressed on par with other chronic diseases.

In what participants termed a “historic” agreement, the coalition of 16 insurance companies — including Horizon Blue Cross Blue Shield of New Jersey — has endorsed a set of eight basic principles they expect will improve healthcare outcomes and save lives nationwide. These goals will also help Horizon as it develops plans for localized treatment in the Garden State, the company said.

Leaders of the national coalition, which together insures some 248 million Americans, also hope the model will become a national playbook for addressing substance-use disorders. They envision it will lead to a scorecard of treatment outcomes that would enable patients to choose effective providers and allow insurance companies to identify successful partners.

“This is the first step toward a clear, measurable solution,” said Dr. Thomas McLellan, former deputy director of the Office of National Drug Control Policy and a scientific advisor to Shatterproof, a nonprofit that led the effort to develop the standards. “It can honestly be said that now with proper treatment, recovery is an expectable outcome,” he said.

Reducing stigma

The effort reflects a growing interest in reducing the stigma around addiction and providing treatment analogous to the care that would be given for diabetes, heart disease, or other chronic diseases. These themes have found their way into more state programs — including efforts to expand access to medication-assisted treatment, or MAT, now considered the gold standard for opiate recovery — and are reflected clearly in the final draft report from the White House commission on opioid addiction, chaired by Gov. Chris Christie.

The eight principles call for universal screenings for substance-use disorders; the creation of personalized treatment plans; rapid access to appropriate treatment; long-term monitoring; medical and behavioral care for health conditions; and access to approved medications and nonmedical support services. Horizon and other insurance companies said the agreement is not likely to change the scope of coverage at first — generally these services are already covered for addiction diagnoses, they said — but it will help them define quality care for these conditions.

Leaders at Shatterproof convened a task force last spring to draft these goals based on
a 2016 report from former U.S. Surgeon General Vivek Murthy, who documented the history of the nation’s opioid epidemic and outlined options for improving treatment, including a call to physicians to cut back on the addictive pills they prescribe. The principles are also informed by decades of scientific research that have demonstrated what treatments are effective and what approaches fall short.

McLellan called the recommendations “as close to unassailable truths as possible,” but noted they had not yet been put into motion.

‘Research into action’

Shatterproof founder, chairman and CEO Gary Mendell — who lost his own son to addiction in 2011 — said the plan is to “turn this research into action,” adding, “today we are working to slow the opiate epidemic with proven medical treatment.”

Nationwide, some 21 million Americans are struggling with drug addictions, the group said, but only one in 10 is getting proper treatment. In New Jersey, Medicaid alone is covering treatment for more than 41,000 members and tens of thousands of more seek private treatment each year; nearly 2,000 residents died of the disease in 2016.

While many efforts to drive public policy start with government programs, like Medicaid, Mendell — a former entrepreneur and hotel executive — said the commercial insurance companies were more nimble and could move more quickly to adopt changes. Many are already struggling with improving substance-use disorder treatment in their own areas, he said, and embraced the coalition’s goals quickly.

“They were all eager to get moving on this initiative very, very quickly,” Mendell said. “Payers will now begin to establish an accountability process that will systemically change and significantly improve the way that treatment for addiction is delivered in our country.”

Mary Ann Christopher, vice president for clinical operations and transformation at Horizon, said the principles fit well with other work the company has been doing to address addiction in New Jersey. The company has worked with the Partnership for a Drug Free New Jersey to host a series of town hall meetings, based in part on the surgeon general’s report, with law enforcement, public officials, community organizations and providers working together to identify models that are working well.

The main goal, Christopher said, “is to build a catalog of best practices from each of these communities that we will be able to aggregate, share, and scale.” The company is already testing some multisector approaches that they expect will help them “expand the continuum of substance-use disorder care, both vertically and horizontally,” she added.

“We have built our approach to the opioid crisis around the idea that healthcare solutions have to exist in the communities where our members live, work, and play,” Christopher said. The national principles, she added, are “furthering the goal of putting substance-use disorders on the same plane as other chronic disorders.”