Caroline Carney, MD, MSc, FAPM, CPHQ

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When it comes to helping members recover from opioid addiction, the relationships that managed care teams build with community resources can be leveraged as a healing agent, empowering individuals to return to health while rebuilding their lives.

We know the brain circuits associated with motivation, inhibition and stress tolerance are often severely affected in individuals suffering from substance use disorder (SUD). That’s why rapid access to appropriate care is critical: periods of motivational readiness are rarely sustainable. For those suffering from opioid addiction, the stakes are particularly high. According to the CDC, 

 of drug overdose deaths involve an opioid, and 

 die from opioid overdose each day, clearly a harbinger of a population health crisis.

Individuals who are deeply immersed in addiction need the support of and deep involvement in the community in which they live to successfully recover long-term. That’s why the work of managed care organizations and their leaders in providing the foundation for a supportive recovery culture within the individual’s community is critical to breaking the cycle of abuse and preventing relapse. In fact, the American Society of Addiction Medicine guidelines for medication-assisted therapy (MAT) state that psychosocial treatment-including supportive counseling, links to existing family supports and referrals to community resources-are all recommended.

Below are four key ways healthcare executives can leverage community resources to strengthen the availability of tools that support recovery from opioid addiction.

 Establish family therapy programs for those impacted by SUD

. Difficulties managing family conflict are a

to opioid abuse. Additionally, when parents or other family role models have relaxed attitudes toward drug use or use drugs themselves, children may be more likely to abuse drugs.

Family therapy has been proven to be effective

 in supporting recovery for both children and adults. Critical components of family therapy should include cognitive behavioral techniques, an emphasis on interpersonal relations, and development of the skills needed to address future issues without intervention. Adolescent-focused family therapy should include education centered around the specific needs of teenagers. Adult-focused therapy may benefit from education around behavioral theories of change.

For family members impacted by SUD, it’s also important to offer a safe place in the community as an outlet to discuss how they feel and connect with peers who are experiencing the same thing, particularly for children and adolescents.

Take a look at the availability of family therapy programs in communities where high numbers of members in opioid recovery reside. Family therapy ideally should be run by a professional counselor or substance abuse professional. Where no such program exists, consider reaching out to in-network substance abuse professionals as well as churches or YMCAs to develop one.

Develop programs that meet the needs of specific populations most at risk for addiction in your community

 make certain populations more prone to addiction. For example, recent statistics estimate that 

 of the LGBTQ community faces substance abuse challenges, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), compared with about 9% of the general population. Similarly, the prevalence of substance abuse among Native Americans and Alaskan Natives is markedly higher than the general population. SAMHSA data also show that 18 to 25 year olds have the highest rates of prescription drug misuse. It’s imperative that programs that address the specific social, cultural, and age appropriate needs are available.

Managed care organizations can leverage claims data to identify specific populations at risk, then work with community agencies to develop targeted outreach. One approach to consider: Form an opioid addiction and recovery task force with local healthcare and community leaders to discuss the challenges providers and community service agencies are experiencing. Such a forum also can be used to exchange insights and ideas on ways to better support prevention and recovery.

Another consideration for managed care organizations is the structuring of value-based payment contracts to encourage providers to incorporate community resources into their referral and collaboration patterns. For instance, if a community church organization provides a venue for wellness education or support groups for addiction, either the managed care organization or provider could direct members to those organizations. Meanwhile, community organizations could benefit from either quality-program funding or foundation grants.

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Provide community and professional education around evidence-based treatments

. Medication assisted treatment (MAT) works by decreasing opioid cravings and mitigating the effects of withdrawal. In one 

, more than half of patients treated with MAT reported opioid abstinence 18 months after beginning treatment. However, the stigma that’s often associated with treatments such as MAT continue to limit its usage across the industry.

For example, there is a common misconception that MAT simply enables patients to replace one addiction with another. Additionally, federal requirements to administer MAT contribute to low adoption rates among many physicians. Today, while 900,000 U.S. physicians prescribe opioids, 

 are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction.  Even fewer of these actually participate in prescribing MAT.

By providing education around evidence-based treatments such as MAT, outcomes for those suffering from opioid addiction will improve, and the stigma associated with prescribing or receiving MAT will begin to be diminished. Managed care leaders should consider working with healthcare providers to host lunch-and-learn sessions on MAT for physicians, nurses and staff. They can also work with local agencies to offer presentations for community members, including loved ones supporting the patient’s recovery journey. Encouraging loved ones to seek support through organizations like NAR-ANON or via the SAMHSA hotline (1-800-662-HELP) is also beneficial.

Invest in resources for counseling and case management

. For example, in communities with limited resources for one-on-one professional support during the opioid recovery journey, telehealth services are one option. Telehealth case managers can serve as the addict’s first point of contact throughout the recovery process. They can also assist physicians and staff in detecting the warning signs of opioid addiction and relapse.

Telehealth case managers, counselors, and other providers can be game-changers in setting the stage for successful recovery. They can also give those suffering from opioid addiction a stronger sense of community by positioning local resources as a source for accessing specialized counseling or support and providing regular interactions with local agencies and support groups.

In Medicaid populations, managed care organizations may consider making certified peer recovery specialists part of the case management team. Organizations also may wish to make peer support and other community-based prevention and recovery programs a covered benefit for commercial lives, using data to demonstrate the impact on outcomes.

A community-based approach to opioid recovery

Medical treatment for opioid addiction and community support for recovery should not be mutually exclusive. Rather, they should be integral components of a holistic approach to treatment.

There are few communities that have been untouched by the opioid crisis. By strengthening the availability of resources that address the root cause of addiction and equipping those suffering from addiction with the tools they need to successfully reenter society, managed healthcare organizations can better support recovery-and save lives.

Caroline Carney, MD, MSc, FAPM, CPHQ, is chief medical officer, 

Articles

Here are 4 key ways healthcare executives can leverage community resources to strengthen the availability of tools that support recovery from opioid addiction.

Author | Caroline Carney, MD, MSc, FAPM, CPHQ

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