Program uses provider, patient incentives to fight opioid epidemic

October 18, 2017

Providers are coming up short when it comes to HEDIS measures related to substance abuse. Here’s how one health plan is changing that.

Fifteen HEDIS measures are tailored to behavioral health, including two measures specifically addressing substance abuse:

  • The Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET) measure applies to patients 13 years of age and older experiencing a new episode of substance abuse. The goal is to initiate an appointment for care within 14 days of the index appointment (when the problem was first diagnosed), with two engagement appointments within 34 days of the initiation appointment (the first appointment addressing the issue).

  • The Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence measure also applies to patients 13 years and older, and sets of a goal of follow-up appointments at seven and 30 days after an emergency department visit.

National averages for these measures are not good, with just 38.07% of providers scoring in the 50th percentile for meeting the initiation phase of the IET measure, and 9.63% scoring in the 50th percentile for the engagement phase.

PowellThat’s according to Traci E. Powell, MD, CPE, FAPA, behavioral health medical director at Harmony Health Plan, who discussed how to optimize measures related to opioid and other substance abuse at the 7th Annual HEDIS & Quality Improvement Summit in Miami on October 17.

The problem, Powell says, is multifaceted. Providers lack time and resources for referral, don’t understand the measures fully, and are working with a population that is often lacking motivation for change.

Insurers face barriers, too, and often are unable to reach members for follow-up and get claims information too late to offer appropriate support.

What to do

Powell says providers and insurers need to get creative when it comes to making improvements on these measures.

“It’s about really helping patients and providers to feel comfortable and empower them to get to that next level of care,” she says.

Powell outlined an incentive program created at Harmony Health to try and improve access to care and follow-up. Providers are incentivized with a $50 referral bonus on top of claims payment when patients are referred to an appropriate substance abuse provider and an appointment is scheduled. The provider then receives a service completion bonus if the patient follows through with the appointment.

To tackle the problem from the other end, patients also receive a $10 Subway gift card for attending their initiation appointment, and a $15 Subway gift card for attending their engagement appointment.

The goal of the program is to incentivize busy providers to take the extra step in trying to get the patient into a long-term care program, and to motivate patients to make a change.

Program results

It’s too soon to assess the impact of the program at Harmony, but Powell says first quarter expenditures for incentives have totaled $13,000. The payoff for that, according to initial results, was an increase of 10% in initiation appointments and a 6.5% increase in engagement appointments between the first and second quarters, she says.