Experiences of three states implementing the Medicaid health home model to address opioid use disorder—Case studies in Maryland, Rhode Island, and Vermont

Clemans-Cope, Lisa; Wishner, Jane B.; Allen, Eva Hruba; Lallemand, Nicole; Epstein, Marni; Spillman, Brenda C.

doi:10.1016/j.jsat.2017.10.001

Cited by 25 publications

(14 citation statements)

References 3 publications

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“…The experiences of states in which most treatment facilities offer MT—Rhode Island, New York, and Vermont—may provide guidance to other states that are facing high or increasing opioid overdose death rates. 28,41–44 The experience of the Department of Veterans Affairs also provides useful guidance for organizationwide initiatives. 45 Curbing the opioid epidemic will likely require a multipronged approach that involves both prevention and treatment initiatives.…”

Section: Discussionmentioning

confidence: 99%

Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities

et al. 2019

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Medication treatment (MT) is one of the few evidence-based strategies proposed to combat the current opioid epidemic. We examined national trends and correlates of offering MT in substance use treatment facilities in the United States. According to data from national surveys, the proportion of these facilities that offered any MT increased from 20.0 percent in 2007 to 36.1 percent in 2016—mainly the result of increases in offering buprenorphine and extended-release naltrexone. Only 6.1 percent of facilities offered all three MT medications in 2016. Facilities in states with higher opioid overdose death rates, facilities that accepted health insurance overall (and, more specifically, those that accepted Medicaid in states that opted to expand eligibility for Medicaid), and facilities in states with more comprehensive coverage of MT under their Medicaid plans had higher odds of offering MT. The findings highlight the persistent unmet need for MT nationally and the role of expansion of health insurance in the dissemination of these treatments.

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Section: Discussionmentioning

confidence: 99%

Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities

et al. 2019

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“…An alternative model used in Vermont’s Medicaid health home program for people with opioid use disorders is the hub-and-spoke model. In this payment model, reimbursement is split between the hub (specialty substance use treatment programs implementing health homes) and spokes (team of collaborating PCPs) 29 providing financial incentive for external provider participation in the health home.…”

Section: Discussionmentioning

confidence: 99%

Care Coordination and Population Health Management Strategies and Challenges in a Behavioral Health Home Model

Daumit¹,

Kennedy-Hendricks

Choksy³

et al. 2019

Medical Care

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Objective: Behavioral health home (BHH) models have been developed to integrate physical and mental health care and address medical comorbidities for individuals with serious mental illnesses (SMIs). Previous studies identified population health management capacity and coordination with primary care providers (PCPs) as key barriers to BHH implementation. This study examines the BHH leaders’ perceptions of and organizational capacity to conduct these functions within the community mental health programs implementing BHHs in Maryland. Methods: Interviews and surveys were conducted with 72 implementation leaders and 627 front-line staff from 46 of the 48 Maryland BHH programs. In-depth coding of the population health management and primary care coordination themes identified sub-themes related to these topics. Results: BHH staff described cultures supportive of evidence-based practices, but limited ability to effectively perform population health management or primary care coordination. Tension between population health management and direct, clinical care, lack of experience, and state regulations for service delivery were identified as key challenges for population health management. Engaging PCPs was the primary barrier to care coordination. Health information technology (HIT) and staffing were barriers to both functions. Conclusions: BHHs face a number of barriers to effective implementation of core program elements. To improve programs’ ability to conduct effective population health management and care coordination and meaningfully impact health outcomes for individuals with SMI, multiple strategies are needed, including formalized protocols, training for staff, changes to financing mechanisms, and HIT improvements.

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“…Treating both physical addiction and the associated mental health symptoms in primary care settings is a promising model for the treatment and eradication of opiate misuse (Chou et al, 2016). Chou and colleagues noted that although psychosocial services were consistently mentioned as essential components to successful MAT models of care, they found "the degree to which psychosocial services are integrated into the MAT treatment setting, the intensity of psychosocial treatments, and the intensity of psychosocial services, varied even within programs implementing the same model of care" (p. 10).…”

Section: Psychosocial Interventions As Components Of Office-based Opimentioning

confidence: 99%

Psychosocial Interventions in Office-Based Opioid Treatment: A Systematic Review

Zerden

Guan

Lombardi

et al. 2020

Journal of the Society for Social Work and Research

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Medication-assisted treatment (MAT) in office-based opioid treatment (OBOT) is expanding treatment of opioid use to primary care settings. OBOT combines MAT and behavioral health interventions; however, the literature varies on best practices. This review focuses on psychosocial interventions as an OBOT component. Method: Protocol and eligibility criteria were published on PROSPERO; intervention characteristics, setting, provider, location, and duration were considered. Results: Search results and initial screening yielded 539 articles for abstract review; 67 articles were retained for full-text review. Of these, 30 articles (reporting on 25 studies) met inclusion criteria. The majority of studies were conducted in academic medical centers (72%), primarily in the Northeast U.S. Study samples consisted of a majority of men and White participants. Psychosocial interventions included individual counseling (88%), mutual help programs (36%), group counseling (28%), case management (24%), and referral to outpatient treatment (24%). Therapeutic approaches used motivational interviewing, cognitive behavioral therapy, and 12-step facilitation. Interventions were administered by interprofessional providers-most frequently medical providers, social workers, and a variety of behavioral health providers. Conclusions: Despite progress in expanding OBOT, a critical need remains to identify and support psychosocial interventions as essential, concurrent components of MAT. Implications for practice, workforce, team-based care, and future research needs are addressed.

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Experiences of three states implementing the Medicaid health home model to address opioid use disorder—Case studies in Maryland, Rhode Island, and Vermont

Cited by 25 publications

References 3 publications

Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities

Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities

Care Coordination and Population Health Management Strategies and Challenges in a Behavioral Health Home Model

Psychosocial Interventions in Office-Based Opioid Treatment: A Systematic Review

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