States Promote Integrated Care for Individuals with Opioid Dependency

According to a January 2015 brief titled Designing Medicaid Health Homes for Individuals with Opioid Dependency: Considerations for States, over the past 10 years “increasing rates of opioid dependency have become a concern for public health officials, state Medicaid agencies, and the federal government”. In 2010, nearly 600,000 people in the United States used heroin and 12 million used prescription painkillers for nonmedical reasons. Significant morbidity and mortality associated with illegal opioid use has resulted in increased health care utilization and high costs. In 2009, about 500,000 emergency department visits were due to abuse or misuse of prescription painkillers, and health insurers spent $24 billion on the treatment of substance use disorders, 21% of which was spent by Medicaid.

Furthermore, those with opioid dependence “often have complex social, physical, or behavioral health comorbidities” and “could benefit from increased care management.” Thus, to ensure that Opioid Treatment Programs (OTPs),  are coordinated with other necessary physical and behavioral health services, state Medicaid agencies have approved plans to implement health home models as a means to “to promote integrated care for individuals with opioid dependency.” These Medicaid health home state plans provide access to and help to coordinate “primary and acute physical and behavioral health services”. OTPs are appropriately suited to do the same due to the varying needs of the patients they serve.  

Three states—Maryland, Vermont, and Rhode Island—offer options for designing Medicaid health homes focused on opioid dependence. Although they differ in provider structure, type of enrollment, health home provider teams, and approach to payment, these states’ models share some common features:

  • Statewide implementation

  • OTPs as designated providers

  • Definitions of eligible populations

Ultimately, states can move towards an integrated health care delivery approach to treating substance use disorders with those common characteristics, as well as:

  • OTPs that better encompass key health home components;

  • multi-agency collaboration to develop opioid health homes;

  • education, and support for providers creating opioid health homes; and

  • sharing of information between providers.

Access the related summary and brief.