We know that it is challenging to find science-based treatment for substance use disorder (SUD) and that families struggle immensely to navigate the treatment and insurance processes. There are a multitude of reasons why this is the case.

Individuals face tremendous barriers when seeking treatment. One of these barriers is payment.

Specialty care can be expensive, there might not be enough providers in your insurance network, and most people do not have disposable income to spend on specialists that are out-of-network.

In fact, approximately 80% of patients seeking behavioral health care do so in a primary care setting.

Primary care settings have become the de facto behavioral health system for most adults. However, providers in these settings often lack behavioral health expertise or resources and diagnostic tracking tools specific to SUD.

The reality is that we are currently treating addiction in emergency rooms after acute episodes like an overdose occur.

However, we know that treating a disease with an early diagnosis often results in better outcomes. So in order to start treating addiction at stage 1 of the disease, we need tools for integration of behavioral health care within primary care.

States have gotten creative given the challenges with payment for specialty treatment and lack of accessible providers. 

For example, Vermont has implemented an innovative model called Hub and Spoke for opioid use disorder services. In the mental health community, they have been using the Collaborative Care Model (CoCM) to integrate behavioral health care into primary care settings. Through this approach, providers measure patient progress with a team of clinicians typically including a primary care physician, a behavioral health specialist and care coordinator. This approach has shown to be tremendously successfully in improving outcomes for patients. 

Medicaid covers 17% of adults with a SUD and has a significant number of enrollees more likely to experience comorbid behavioral and chronic medical conditions.

For this reason, Medicaid has a large role to play in adopting CoCM for substance use disorders. 

We need to integrate this model or the core elements of it into the standard practice for treating substance use disorder, so that we are identifying and treating addiction at Stage 1 of the disease.  This will not only improve outcomes for those getting treatment earlier, but it will preserve the limited intensive and specialty care for those who need it most.

Interested in learning more about how we can get this done?

Read Shatterproof’s White Paper on collaborative care.