{"id":2106,"date":"2018-10-09T06:04:13","date_gmt":"2018-10-09T13:04:13","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=2106"},"modified":"2018-10-09T06:04:13","modified_gmt":"2018-10-09T13:04:13","slug":"alcohol-and-drug-use-and-health-care-expenses","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=2106","title":{"rendered":"Alcohol and Drug Use and Health Care Expenses"},"content":{"rendered":"

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer<\/strong><\/p>\n

In 2017, Partnership HealthPlan (PHC) spent $178 million to provide inpatient medical care for members with a primary or secondary diagnosis of a substance use disorder (SUD).\u00a0 This represents about 24% of all PHC-covered hospital costs (including costs for maternity and pediatric inpatient care).<\/p>\n

Studies done at Kaiser South Sacramento found that an integrated approach to treatment of Substance Use Disorder (mainly Alcohol and Opioid Use Disorders) reduced inpatient hospital and ER visits, saving about $1.44 for every $1.00 spent on integrated treatment (combining SUD treatment, mental health treatment and physical health treatment).\u00a0 In terms of scale, the potential impact is impressive and inspiring.<\/p>\n

PHC is pursuing 3 strategies to improve the quality of life for our members with SUD:<\/p>\n

    \n
  1. A regional model for health plan administration of traditional SUD services<\/li>\n
  2. Support for housing high cost members affected by homelessness<\/li>\n
  3. Bolstering the treatment of SUD within primary care and acute care hospital settings.<\/li>\n<\/ol>\n

    Regional Model:<\/u><\/strong>\u00a0 First, Partnership HealthPlan is in the midst of negotiations with the California Department of Health Care Services to develop a regional model for providing Substance Use Services to the Medi-Cal population.\u00a0 These services would include outpatient and residential treatment, as well as Opioid Treatment Centers or \u201cMethadone clinics.\u201d\u00a0 The provider network for these services is very thin in our service area, so PHC is working to increase capacity.\u00a0 No other Medi-Cal Managed Care plan in California is seeking to integrate SUD services, although many other states in the United States have done so.<\/p>\n

    Homelessness:<\/u><\/strong>\u00a0 Second, the combination of homelessness with substance use is associated with high costs. \u00a023% of inpatient expenses for 2017 were incurred by members who were homeless. Studies show that previous policies that required treatment of substance use before offering housing have mostly not helped.\u00a0 The current trend is \u201chousing first\u201d where housing plus intensive social support is provided, resulting in lower utilization of health care resources and more success in reducing substance use.<\/p>\n

    In 2017, the PHC invested $25 million to complement local funding to address homelessness, with particular emphasis on those with the highest use of resources.<\/p>\n

    Leveraging our Current Providers<\/u>:<\/strong>\u00a0 Services addressing SUD on different levels can be provided in our current PHC network, including primary care and acute care hospital settings.<\/p>\n

    Primary care<\/u> can include medication-assisted therapy for opioid use disorder and home or community based alcohol withdrawal management.\u00a0 When provided with behavioral health counselling (in many of our Health Centers), this integrated environment has proved successful.\u00a0 Substance use services provided by primary care clinicians is paid by PHC when provided by PHC primary care or mental health clinicians who are addressing mental health conditions such as depression and anxiety.<\/p>\n

    Current PHC initiatives<\/u> support our goal to reduce the burden of SUD in our community:<\/p>\n