Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model

Fried, Jonathan E; Basu, Sanjay; Phillips, Russell S.; Landon, Bruce E.

doi:10.1370/afm.2587

Cited by 7 publications

(14 citation statements)

References 36 publications

(40 reference statements)

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“…Analyzing the literature for growth opportunities suggest that implementation of these changes along with new important legislation may lead to improved clinician satisfaction [30,33], improved overall rural community health [48], increased utilization of primary care services [48], and increased revenue that can help sustain rural healthcare offices [49].…”

Section: Future Directions As a Results Of New Legislationmentioning

confidence: 99%

“…We also suggest the consideration of incentives that will increase the level of provider participation, including but not limited to decreased prescriber regulations (i.e., prior authorization requirements) and increased reimbursements for services provided. Analyzing the literature for growth opportunities suggest that implementation of these changes along with new important legislation may lead to improved clinician satisfaction [ 30 , 33 ], improved overall rural community health [ 48 ], increased utilization of primary care services [ 48 ], and increased revenue that can help sustain rural healthcare offices [ 49 ].…”

Section: Reviewmentioning

confidence: 99%

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Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Gregory¹,

Hill²,

Parker³

2021

Cureus

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Buprenorphine/Naloxone (Suboxone®) is an efficacious treatment for opioid use disorder (OUD) due to its more convenient dosing, superior safety profile, and decreased incidence of negative side effects when compared to other forms of medications for opioid use disorder (MOUD). In the United States, updated legislation in 2021 entitled, "The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder", released by the Department of Health and Human Services, creates an exemption for the previously required Drug Addiction Treatment Act of 2000 (DATA) waiver for buprenorphine prescribing for clinicians. This legislation was born out of a need for making MOUD more accessible for patients living with OUD as rates of opioid-related deaths in the United States have continued to rise and have increased disproportionately during the time period of the COVID-19 pandemic. This legislation has the potential to improve access to MOUD across all geographic locations, but may have the most profound impact in rural areas where significant disparities and challenges still exist in patients’ ability to access buprenorphine. The purpose of this literature review is to 1) examine how MOUD prescribing has changed after previous legislation changes, 2) explore the current state of buprenorphine access for treatment of OUD in rural America, 3) detail existing barriers in patients' ability to access MOUD, and 4) discuss future directions and considerations as a result of new legislation. This literature review found several existing barriers to receiving MOUD such as increasing costs, insufficient education, significant stigma, and the need for more innovative methods of delivery. We also found that there is currently a large opportunity for growth in the number of rural clinicians able to prescribe buprenorphine, particularly in primary care, that may now occur as a result of this new legislation. Overall, this legislation has the potential to have a positive impact on combating OUD, especially in rural areas, and may be a critical step towards ending the current opioid epidemic in the United States as these described barriers are addressed.

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Section: Future Directions As a Results Of New Legislationmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Gregory¹,

Hill²,

Parker³

2021

Cureus

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“…Our model simulates individual patients of any age who visit a primary care practice for health care; their self-reported social needs in the domains of food, housing, transportation, and community-based care coordination needs; their enrollment in existing programs to address those social needs; their eligibility and enrollment rates after screening and referral from their primary care practice to additional social needs interventions; and the associated costs of the interventions (Figure 1). We subset the results by practice type of the patient’s primary care practice (subtypes of federally qualified health centers [FQHCs] and look-alikes, non-FQHC urban practices in high-poverty areas [defined as ≥20% of the population in the practice’s county under the federal poverty threshold], non-FQHC rural practices in high-poverty areas, and practices in lower-poverty areas) and by quartiles of Area Deprivation Index (ADI) level assigned based on the patient’s census tract of residence, which is a composite area level metric of social risk . A microsimulation method was chosen because the microsimulation approach can prospectively estimate the national-level expenditures and variations in those expenditures that would be expected across practice types and geographies nationwide .…”

Section: Methodsmentioning

confidence: 99%

Estimated Costs of Intervening in Health-Related Social Needs Detected in Primary Care

Basu¹,

Berkowitz

Davis

et al. 2023

JAMA Intern Med

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ImportanceHealth-related social needs are increasingly being screened for in primary care practices, but it remains unclear how much additional financing is required to address those needs to improve health outcomes.ObjectiveTo estimate the cost of implementing evidence-based interventions to address social needs identified in primary care practices.Design, Setting, and ParticipantsA decision analytical microsimulation of patients seen in primary care practices, using data on social needs from the National Center for Health Statistics from 2015 through 2018 (N = 19 225) was conducted. Primary care practices were categorized as federally qualified health centers (FQHCs), non-FQHC urban practices in high-poverty areas, non-FQHC rural practices in high-poverty areas, and practices in lower-poverty areas. Data analysis was performed from March 3 to December 16, 2022.InterventionSimulated evidence-based interventions of primary care–based screening and referral protocols, food assistance, housing programs, nonemergency medical transportation, and community-based care coordination.Main Outcomes and MeasuresThe primary outcome was per-person per-month cost of interventions. Intervention costs that have existing federally funded financing mechanisms (eg, the Supplemental Nutrition Assistance Program) and costs without such an existing mechanism were tabulated.ResultsOf the population included in the analysis, the mean (SD) age was 34.4 (25.9) years, and 54.3% were female. Among people with food and housing needs, most were program eligible for federally funded programs, but had low enrollment (eg, due to inadequate program capacity), with 78.0% of people with housing needs being program eligible vs 24.0% enrolled, and 95.6% of people with food needs being program eligible vs 70.2% enrolled. Among those with transportation insecurity and care coordination needs, eligibility criteria limited enrollment (26.3% of those in need being program eligible for transportation programs, and 5.7% of those in need being program eligible for care coordination programs). The cost of providing evidence-based interventions for these 4 domains averaged $60 (95% CI, $55-$65) per member per month (including approximately $5 for screening and referral management in clinics), of which $27 (95% CI, $24-$31) (45.8%) was federally funded. While disproportionate funding was available to populations seen at FQHCs, populations seen at non-FQHC practices in high-poverty areas had larger funding gaps (intervention costs not borne by existing federal funding mechanisms).Conclusions and RelevanceIn this decision analytical microsimulation study, food and housing interventions were limited by low enrollment among eligible people, whereas transportation and care coordination interventions were more limited by narrow eligibility criteria. Screening and referral management in primary care was a small expenditure relative to the cost of interventions to address social needs, and just under half of the costs of interventions were covered by existing federal funding mechanisms. These findings suggest that many resources are necessary to address social needs that fall largely outside of existing federal financing mechanisms.

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“…In several of the case studies reviewed below, financial viability depended on assumptions about staff productivity. For example, in a simulation study Fried et al used assumptions about physician hours and NCM hours provided per patient per year in each of 4 delivery models (e.g., 2.0 and 4.0 respectively in a nurse-led model)[ 45 ].…”

Section: Funding the New Services Needed For Obotmentioning

confidence: 99%

“…Fried et al recently published a study simulating the effect of OBOT adoption that was based on the experience of 20 primary care practice leaders engaged in buprenorphine prescribing in the United States [ 45 ]. They considered the effects of 4 model types (with varying division of labor among clinicians) in 4 different settings (varying by rurality, poverty and whether a CHC).…”

Section: Evidence On Requirements For Financial Sustainabilitymentioning

confidence: 99%

Financial sustainability of payment models for office-based opioid treatment in outpatient clinics

Hodgkin

Horgan

Bart

2021

Addict Sci Clin Pract

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Background Office-Based Opioid Treatment (OBOT) is a delivery model which seeks to make medications for opioid use disorder (MOUD), particularly buprenorphine, widely available in general medical clinics and offices. Despite evidence supporting its effectiveness and cost-effectiveness, uptake of the OBOT model has been relatively slow. One important barrier to faster diffusion of OBOT may be the financial challenges facing clinics that could adopt it. Methods We review key features and variants of the OBOT model, then discuss different approaches that have been used to fund it, and the findings from previous economic analyses of OBOT’s impact on organizational finances. We conclude by discussing the implications of these analyses for the financial sustainability of the OBOT delivery model. Results Like other novel services, OBOT poses challenges for providers due to its reliance on services which are ‘non-billable’ in a fee-for-service environment. A variety of approaches exist for covering the non-billable costs, but which approaches are feasible depends on local payer policies. The scale of the challenges varies with clinic size, organizational affiliations and the policies of the state where the clinic operates. Small clinics in a purely fee-for-service environment may be particularly challenged in pursuing OBOT, given the need to fund a dedicated staff and extra administrative work. The current pandemic may pose both opportunities and challenges for the sustainability of OBOT, with expanded access to telemedicine, but also uncertainty about the durability of the expansion. Conclusion The reimbursement environment for OBOT delivery varies widely around the US, and is evolving as Medicare (and possibly other payers) introduce alternative payment approaches. Clinics considering adoption of OBOT are well advised to thoroughly investigate these issues as they make their decision. In addition, payers will need to rethink how they pay for OBOT to make it sustainable.

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Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model

Cited by 7 publications

References 36 publications

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Estimated Costs of Intervening in Health-Related Social Needs Detected in Primary Care

Financial sustainability of payment models for office-based opioid treatment in outpatient clinics

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