Impact of recovery support navigators on continuity of care after detoxification

Lee, Margaret T.; Torres, Maria; Brolin, Mary; Merrick, Elizabeth L.; Ritter, Grant; Panas, Lee; Horgan, Constance M.; Lane, Nancy E.; Hopwood, Jonna; Marco, Natasha De; Gewirtz, Andrea

doi:10.1016/j.jsat.2020.01.019

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…Further, longer engagement has been shown to impact the quantity and quality of community-based services utilized by clients [ 25 ]. Analysis of the full claims data sample assessing service use and health care costs supports this assertion, showing increased rates of initiation with SUD treatment [ 26 ] and a shift in service use from more to less acute settings for the intervention group sample compared to TAU [ 18 ]. It also showed a slower rate of growth in health care spending for intervention group members than for TAU [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study

Torres

Brolin

Panas

et al. 2020

BMC Health Serv Res

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Background Acute 24-h detoxification services (detox) are necessary but insufficient for many individuals working towards long-term recovery from opiate, alcohol or other drug addiction. Longer engagement in substance use disorder (SUD) treatment can lead to better health outcomes and reductions in overall healthcare costs. Connecting individuals with post-detox SUD treatment and supportive services is a vital next step. Toward this end, the Massachusetts Medicaid program reimburses Community Support Program staff (CSPs) to facilitate these connections. CSP support services are typically paid on a units-of-service basis. As part of a larger study testing health care innovations, one large Medicaid insurer developed a new cadre of workers, called Recovery Support Navigators (RSNs). RSNs performed similar tasks to CSPs but received more extensive training and coaching and were paid an experimental case rate (a flat negotiated reimbursement). This sub-study evaluates the feasibility and impact of case rate payments for RSN services as compared to CSP services paid fee-for-service. Methods We analyzed claims data and RSN service data for a segment of the Massachusetts Medicaid population who had more than one detox admission in the last year and also engaged in post-discharge CSP or RSN services. Qualitative data from key informant interviews and Learning Collaboratives with CSPs and RSNs supplemented the findings. Results Clients receiving RSN services under the case rate utilized the service significantly longer than clients receiving CSP services under unit-based billing. This resulted in a lower average cost per member per month for RSN clients. However, when calculating total SUD treatment costs per member, RSN client costs were 50% higher than CSP client costs. Provider organizations employing RSNs successfully implemented case rate billing. Benefits included allowing time for outreach efforts and training and coaching, activities not paid under the unit-based system. Yet, RSNs identified staffing and larger systems level challenges to consider when using a case rate payment model. Conclusions Addiction is a chronic disease that requires long-term investments. Case rate billing offers a promising option for payers and providers as it promotes continued engagement with service providers. To fully realize the benefits of case rate billing, however, larger systems level changes are needed.

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Section: Discussionmentioning

confidence: 99%

Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study

Torres

Brolin

Panas

et al. 2020

BMC Health Serv Res

Self Cite

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“…PRC training sessions were developed by members of the study team and followed a protocol-based approach to improve substance use care (see Section 2.7 ). ( E. Bernstein et al., 1997 ; J. Bernstein et al., 2005 ; Lee et al., 2020 ). Smartphones were provided to all participants for ease of communication and to increase retention in the study.…”

Section: Methodsmentioning

confidence: 99%

Peer recovery coaching for comprehensive HIV, hepatitis C, and opioid use disorder management: The CHORUS pilot study

Martin¹,

PERRYMAN²,

Bernstein³

et al. 2023

Drug and Alcohol Dependence Reports

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“…The explanatory variables of interest included factors hypothesized to influence linkages to SUD treatment after detoxification treatment based on past literature. [7][8][9]14 Socio-demographic variables included age (per year older), gender (male vs nonmale), self-reported race/ethnicity (White vs Black, Indigenous, or People of Color), and highest level of education (not completed high school vs completed high school). We also included variables representing HIV status (positive vs negative serology) and substance use-related factors, such as daily injection of substances (yes vs no) and money spent on drugs (<CAD$ 50/d vs ≥CAD$ 50/d).…”

Section: Methodsmentioning

confidence: 99%

Medical Detoxification for Nonopioid Substances Is Associated With Lower Likelihood of Subsequent Linkage to Substance Use Disorder Treatment

et al. 2022

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Background: Although factors associated with completion of medical detoxification treatment for substance use disorders (SUD) are well described, there is limited information on barriers and facilitators to subsequent linkage to SUD treatment in the community. This study aimed to evaluate correlates of successful linkage to community SUD treatment on discharge. Methods: Data were drawn from 2 prospective cohorts of people who use unregulated drugs in Vancouver, Canada between December 2012 and May 2018. Multivariable generalized estimating equations were used to investigate factors associated with linkage to community SUD treatment in the 6-month period after attending detoxification treatment. Results: Of the 264 detoxification treatment encounters contributed by 178 people who use unregulated drugs, these were most often (n = 104, 39%) related to polysubstance use, and the majority (n = 174, 66%) resulted in subsequent linkage to community treatment. In the multivariable analysis, compared to attending detoxification treatment for opioid use, attending detoxification treatment for stimulants (adjusted odds ratio [AOR] = 0.23, 95% confidence interval [CI] : 0.10-0.51) and alcohol (AOR = 0.17, 95% CI: 0.06-0.54) were associated with lower odds of subsequent linkage to community treatment. Conversely, later calendar year of detoxification treatment remained associated with higher odds (AOR = 1.23, 95% CI: 1.06-1.42). Conclusions: Only two-thirds of detoxification treatment encounters in Vancouver were subsequently linked to community SUD treatment, with those related to nonopioid substances being less likely. Findings suggest the need for tailored interventions for specific substances to improve linkage to SUD treatment in the community on discharge.

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Impact of recovery support navigators on continuity of care after detoxification

Cited by 8 publications

References 31 publications

Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study

Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study

Peer recovery coaching for comprehensive HIV, hepatitis C, and opioid use disorder management: The CHORUS pilot study

Medical Detoxification for Nonopioid Substances Is Associated With Lower Likelihood of Subsequent Linkage to Substance Use Disorder Treatment

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