Effects of Global Payment and Accountable Care on Medication Treatment for Alcohol and Opioid Use Disorders

Abstract

Despite incentives for improved integration and quality of care under a global payment contract, the initial 3 years of the AQC showed no impact on MT use for AUD or OUD among privately insured enrollees with behavioral health benefits.

Association of Alternative Payment and Delivery Models With Outcomes for Mental Health and Substance Use Disorders

“…It is noteworthy that qualitative themes and barriers identified in this systematic review were overwhelmingly from evaluations of ACOs (LAN 3 and 4) that spanned a variety of payers and populations, including Medicare, Medicaid, and commercial insurance. 59 , 60 , 61 , 73 , 74 Some of these findings are likely generalizable beyond ACOs. For example, in earlier ACOs that were not designed solely to manage MH/SUD care, these services were not considered low-hanging fruit and were often not an early focus of coordination or integration efforts.…”

“… 36 , 37 , 38 No single primary LAN category predominated in the results ( Table 3 ). 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 …”

“…Three study publications 59 , 60 , 61 (all OCEBM rating 3A) assessed the 3-year MH/SUD outcome associations of the Blue Cross/Blue Shield of Massachusetts Alternative Quality Contract (AQC), a LAN 4B commercial insurance ACO. The AQC compensated participating organizations via a risk-adjusted, prospective payment for all primary and specialty care, with bonuses available based on performance across 64 measures (most unrelated to MH/SUD care).…”

“…Overall, including organizations with and without MH/SUD risk, the AQC was not associated with any changes in SUD medication use or spending. 61 …”

Misalignment of Stakeholder Incentives in the Opioid Crisis

“…Real-world instances of initiatives include the Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration (SAMHSA-HRSA) joint project on expanding the use of medications in safety-net settings [ 92 ], SAMHSA’s Addiction Technology Transfer Center Network [ 93 ], CVS Pharmacy providing naloxone without prescriptions in most states [ 94 ], California implementing a state-wide hub-and-spoke model to improve access to OUD treatments [ 95 ], improving the rate of follow-up treatments among Medicaid enrollees in Pennsylvania by offering incentives to providers [ 96 ], and the SUPPORTAct expanding Medicare coverage to include bundled payment for treatments [ 97 ]. By contrast, in the first three year implementation of Global Payment and Accountable Care by Blue Cross Blue Shield of Massachusetts, no significant impact on using treatments was observed [ 98 ].…”