Abstract
BackgroundAcute 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.MethodsWe 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.ResultsClients 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.ConclusionsAddiction 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.
Highlights
Acute 24-h detoxification services are necessary but insufficient for many individuals working towards long-term recovery from opiate, alcohol or other drug addiction
Case rate billing offers a promising option for payers and providers as it promotes continued engagement with service providers
Using the Medical Research Council (MRC) framework to assess feasibility of case rate billing, we focused on whether case rate billing offered an economical alternative to FFS billing, whether the case rate payment method improved client length of Outreach Only Service Onlya
Summary
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. Connecting individuals with post-detox SUD treatment and supportive services is a vital step. Toward this end, the Massachusetts Medicaid program reimburses Community Support Program staff (CSPs) to facilitate these connections. CSP offers support services to help consumers at high risk of relapse to access and use community-based behavioral health services [10]. Through their employer, CSP workers receive annual training on such topics as engagement and outreach, service coordination and principles of recovery; each employer determines which trainings will be offered [10]. Strict criteria detail the range of services CSP workers can provide, which includes in-person or telephone case management, direct time with clients and providers, and travel, but not outreach services [11]
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