Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment. CONCLUSION

03/06/2019

Identifying mechanisms to enhance SUD treatment initiation and continued engagement in care is a public health priority. Although more than 20.8 million Americans have a diagnosed need for SUD treatment, few access or complete appropriate treatment.[1, 2] As both administrators and coordinators of health care benefits, health plans are positioned to play a crucial role in mitigating potential access barriers and developing facilitating mechanisms that bring beneficiaries into care and keep them there.

This study sought to identify which health plan characteristics--including models of care, interventions, and best practices--are associated with achieving high rates of initiation and engagement in SUD treatment. We aimed to examine additional market factors--including health policies, provider availability, and population characteristics--that affect performance on these measures. Sequential, mixed-method analyses yielded core understandings of how health plans navigate obstacles and leverage opportunities to bring members into SUD treatment and maintain engagement over time.

The following are some ways in which health plans have the potential to address several key barriers while leveraging additional facilitators to achieve high rates of initiation and engagement in SUD treatment. Many of these reflect initiatives undertaken by the higher-performing plans interviewed; others are options that may address some of the barriers identified but not resolved:

  • Coordinating assistance and entitlements for members with competing social demands including childcare, transportation, and housing that otherwise prevent them from attending treatment appointments.

  • Integrating service provision and coordinating treatment plans to address members' holistic physical and behavioral health needs in ways that respond to member-identified priorities.

  • Augmenting provider and outreach staff knowledge of the SUD care continuum and recovery process.

  • Implementing care models that support routine check-ins with members about their readiness for behavior change and include a spectrum of services from harm reduction to more intensive treatment levels that can bring more members into care over time.

  • Developing provider-focused and community-focused campaigns to combat stigma around SUDs and to promote treatment-seeking behaviors, with greater support for members contemplating treatment and for those engaging in the recovery process.

  • Cultivating health plan outreach staff knowledge of and relationships with community-based recovery support services to provide members with additional services beyond the benefit array.

  • Engaging with treatment facilities in educational opportunities that alleviate misinterpretations of federal privacy regulations such as 42 CFR Part 2 to encourage a common legal understanding of information-sharing restrictions that do not unnecessarily hinder health plan outreach and care coordination efforts.

  • Investing resources in developing capabilities for data analytics and responsive activities that accurately respond to the measured needs of members.

  • Scheduling routine communication opportunities between health plan leadership, quality improvement teams, contracting teams, and SUD-focused and mental health-focused teams, including outreach workers and case managers.

Ongoing in-depth examinations of barriers and facilitators to treatment uptake are necessary to continue to understand effective methods of enhancing access to recovery services and supports for the thousands of individuals in need of care. SUD trends change over time. This analysis placed a substantial focus on understanding the specific influences that affect treatment uptake for individuals with an OUD because of the current opioid epidemic. Future research is needed to continue assessing core variables that affect initiation and engagement as drug use patterns evolve and new evidence-based practices are implemented. Close monitoring of how health plan and market characteristics affect access and the efficacy of treatment are crucial to developing processes and models of care that promote and sustain long-term recovery.