Care Coordination for individuals suffering from substance use disorder (SUD) is currently a widely-discussed topic across the country. Individuals with SUD are high risk and complex to manage due to a variety of health and social factors. Providing comprehensive care to these individuals is challenging when the data needed to see a whole picture is absent. Fortunately, multiple factors are now coming together to help complete this picture and expand the possibilities of care for individuals with SUD. Two of these are: new federal legislation around data sharing and additional support from the Centers for Medicare and Medicaid for delivery system reform.
Recently there have been efforts to modernize regulations for data sharing of certain alcohol and drug abuse patient records. On January 13, 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA) revised 42 CFR Part 2—the federal regulations that govern the confidentiality of certain alcohol and drug abuse patient records. This revision will have a significant impact. “Today’s changes will further enhance health services research, integrated treatment, quality assurance and health information exchange activities while at the same time safeguarding the essential privacy rights of people seeking treatment for substance use disorders,” according to HHS Deputy Assistant Secretary, Kana Enomoto. “These efforts clear the way for integrated healthcare models that can provide a better, more cost-effective healthcare system that also empowers people to make key decisions about their healthcare.
Medicaid is playing an increasingly important role in driving the creation of integrated healthcare models for individuals with SUD. One important Medicaid initiative is the 1115 Demonstration Waiver. The aim of these waivers is to enable states to better identify those in the Medicaid population who have an SUD, increase access to care for these individuals, and use quality metrics to evaluate the success of these interventions. The specific goals of the initiative are to:
- Promote strategies to identify individuals with substance use issues or disorders
- Enhance clinical practices and promote clinical guidelines and decision-making tools for serving youth and adults with SUD
- Build aftercare and recovery support services
- Coordinate treatment with primary care and long-term care
- Encourage increased use of quality and outcome measures to inform benefit design and payment models
- Identify strategies to address prescription and illicit opioid addiction
The state of Virginia is leading the way in providing an integrated care model for individuals with SUD. Virginia has proposed a system of care that ensures a seamless transition and information sharing across multiple agencies for a fully integrated care model. The model includes best practices in the addiction treatment field, including the integration of physical health, addiction screening, referrals, withdrawal management, care coordination, and long-term recovery services and supports. Critical elements of Virginia’s Addiction Treatment Service System of Care include:
- Comprehensive evidence-based benefit design
- American Society of Addition Medicine (ASAM) standards of care
- Strong provider network
- Comprehensive care coordination
- Integration of physical health and addiction treatment services
- Compliance with 42 CFR 431.107
As substance use disorder continues to be a public health emergency, it will be even more important for communities to create integrated care models for these individuals. The ClientTrack Care Coordination platform provides the infrastructure and tools needed to assess, track, and manage these patients and share data between their providers.
For information about additional states working to create integrated care models for individuals with SUD, we recommend the following blog from openminds.com.