People with substance use disorder (SUD) experience overlapping, complex care needs that are challenging for health plans and practitioners to address. Policymakers and providers have increasingly recognized that successfully managing these needs – which can include multiple somatic and psychological comorbidities, unmet social needs, monetary and other barriers to accessing care, and stigma – requires uninterrupted, comprehensive, and easy to access clinical and social services. However, services provided by multiple clinical specialists, health systems, and community-based resources can easily become fragmented. Patients as well as their families face the daunting challenge of navigating a complex health care system while dealing with urgent, competing health and social needs. This has led health plans and others to develop care coordination strategies that strive to integrate services to support whole-person care.
As significant providers of high-value care for poor and disabled Americans – a population disproportionately affected by SUD – Association for Community Affiliated Plans (ACAP)-member plans and other Medicaid managed care organizations (MCOs) have proven to be key innovators in the provision of integrated case management and care coordination for these complex patients. MCOs have responded to these challenges with care coordination programs designed to identify treatment gaps, satisfy member needs, develop individualized care plans, and coordinate care delivery. Around the country, MCOs are investing resources in pioneering case management and care coordination strategies for their enrollees with SUD, and are establishing programs and policies that measurably improve the health and safety of these members.
This report highlights innovative models implemented by ACAP Safety Net Health Plans and best practices for providing care coordination and high-quality care to persons with SUD recommended by subject matter experts and identified in emerging literature. The plans contributing to this report represent a diverse array of programs. The four participating plans included Hennepin Health (Minnesota.), CareSource (Ohio), AmidaCare (New York), and Health Plan of San Joaquin (California.). Experts included individuals with deep subject matter expertise on this topic from the federal government, private organizations, and academic institutions.
Although plans varied in size, geographic location, and in their innovative service delivery approaches, there were commonalities in the tactics used to provide comprehensive and coordinated care to persons with SUD. Plans also offered insight into common challenges that they face in serving this complex population including barriers to information sharing due to 42 CFR Part 2 regulations and carve-out financing arrangements, obstacles to engaging and maintaining patients in care, and difficulties in attracting and maintaining a sufficient workforce. Despite those challenges, Safety Net Health Plans continue to innovate and implement new ideas in order to improve care coordination, access, and quality for persons with SUD. Through this important, innovative work, plans can transform care for our most vulnerable populations and offer an example for high quality Medicaid delivery systems across the nation.
This report provides an overview of relevant literature as well as interviews with selected experts and health plans, with the ultimate goal of providing plans seeking to improve SUD care management with practical guidance regarding:
- Approaches to Care Management;
- Member Engagement;
- Social Determinants of Health;
- Data Sharing and Utilization; and
- Overcoming Policy Barriers.