To revolutionize overdose prevention efforts, the manner in which agencies are reimbursed for overdose prevention engagement must be transformed. This critical strategic element is consistently forgotten in the discussion of combatting the overdose epidemic.
Presently, the ways in which managed care organizations support and reimburse OUD prevention, treatment and general recovery services are all too often lacking alignment, coordination or integrated economic structures that incentivize long-term recovery. Even more pointedly, there is often not one entity who assumes ownership of improving an individual’s condition and is properly supported and rewarded for doing so. This leads to a system in which chronic substance disorder patients are engaged by multiple providers without any coordination, volume of services provided is favored over value for the patients, and the hardest to reach, most at-risk individuals are not prioritized.
The Hotspotting program sets out to transform this reimbursement stalemate, as it is an irreplaceable element of fulfilling the dual aim of improving overdose related outcomes and bringing down aggregate healthcare costs in a responsible manner. The program’s central thesis is that by piloting a superior reimbursement scheme and proving its impact on this dual aim, the business case for managed care organizations to adopt this model will be clear and impossible to ignore.
“Opioid use disorder is a chronic illness and payment models for the condition must align with whole health outcomes rather than fragmented treatment incidents. ”
Manager, The Alliance for Addiction Payment Reform