December 19, Wisconsin Health News
A state commission has designed a care delivery model to increase access to treatment for substance use disorder. But critical parts of the model, like how it'll be paid for, still need work.
The report from the Commission on Substance Abuse Treatment Delivery was released at the final meeting of the Governor’s Task Force on Opioid Abuse in Friendship last week.
The commission, created by Gov. Scott Walker in January, met with Medicaid officials, provider associations and others as it developed the model.
The report describes a system of regional “hubs,” with staff specialized in addiction providing high-intensity, medication-assisted treatment, and “spokes” that offer less intensive treatment in the community.
Vermont first developed the hub-and-spoke model, and other states have adopted similar models.
“The model can be viewed as a draft, and a goal to move towards, as it will benefit from further input from additional stakeholders and from individuals with lived experience of addiction,” the report notes.
The report recommends that the treatment initiation process begin within 24 hours of a person seeking care to minimize withdrawal. That capacity isn’t available in the current system, the report notes, describing it as a “long-term goal.”
But a starting point could be emergency departments, where doctors could provide patients with a one- to three-day prescription for buprenorphine, a drug used to treat opioid addiction.
Care teams that provide support throughout treatment and recovery and address the social determinants of health are another critical part of the model. The makeup of the teams could vary, and the report doesn’t specify how they’d be paid for and what requirements they'd need to meet.
Hubs will have to be able to quickly accept transfer patients that spoke clinics can't support. Spokes will also need access to specialized resources to support patients, which could be provided by either the team or the hub. “All services should be available locally across the state,” the report notes.
The report's roadmap toward implementation includes coordinating funding and a call on healthcare payers to change how they pay for care to ensure providers participate in the model. That could include increases in reimbursement rates and incentives for care coordination and delivery.
It’ll also require a “comprehensive monitoring and program evaluation plan" to track performance.
Health information technology and telehealth will play a large role as will regulatory changes aimed at breaking down barriers to accessing medication-assisted treatment, according to the report.
“How services are integrated and provided can look very different in different regions and counties, and it indeed should look different,” the report notes. “The current expectation is not a finished model, but to align the direction and goals that all partners are moving towards.”