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Facility's access to insured patients allows for bed expansion

June 10, 2015
by Alison Knopf, Contributing Writer
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Many more residential addiction treatment beds are needed in Massachusetts to meet demand, especially with regard to treatment for opioid use disorders. Late last month, Spectrum Health Systems took a step toward this goal by opening its new 100-bed addiction treatment center in Westborough. The facility replaces the 80-bed program there, adding 20 beds and at the same time including new amenities, such as a centralized intake area, fitness room, family meeting space, commercial-grade kitchen facilities, media center, outdoor courtyard, and central dining area and great room.

The 40,000-square-foot, three-story building consists of four 25-bed stand-alone residential units. The facility, which will serve both publicly and privately financed patients, was dedicated to Chuck Faris, president and CEO of Spectrum.

Somewhere between 40,000 and 50,000 people a year go through detox in Massachusetts—accounting for multiple admissions, the total number of served individuals is 40,000. There are 1,800 residential beds in the state. Obviously, the math doesn’t add up.

“People come out of detox on a weekly basis, and a residential bed turns over every 90 days,” says Faris.

The “woefully inadequate” rate of $75 a day paid by the Commonwealth doesn’t provide any incentive to expand beds, Faris adds. “It’s not financially possible,” he says. “We’re doing this because we have a market with private pay as well—people who have insurance or who can pay out of their own pocket.”

In the last year, Spectrum also has opened four outpatient facilities in Massachusetts, providing a range of treatment, including methadone and intensive outpatient services. Three more of these centers will be opening soon, Faris says.

One of the reasons Spectrum moved ahead with adding beds was that so many people have had to go out of state for treatment, says Faris. “They’ve gone to Texas, California, Pennsylvania, and of course Florida,” he says. “They went to good facilities, and got good care while they were there, but addiction is a lifetime disease. If you go out of state for 30 days, and then you come back here, where’s your aftercare, where’s your support system?”

Spectrum does operate outside the state, but mainly in corrections. There also is a Spectrum opioid treatment program (OTP) in Maine, where services are currently in question because of the proposal by the governor there to move publicly funded methadone patients to office-based buprenorphine.

Law requires inpatient coverage

Demand for treatment in Massachusetts exceeds capacity, especially in the post-detox phase, says Vicker V. DiGravio III, president and CEO of the Association for Behavioral Healthcare, a membership organization representing community-based mental health and addiction treatment providers in the state. Thanks to state legislation adopted last year, detox and detox stepdown services are now a mandated benefit for commercial insurers. The requirement takes effect Oct. 1, and means that detox and acute care as well as clinical stabilization services (detox stepdown) must be covered.

“We have an opioid epidemic in Massachusetts,” says DiGravio, explaining the impetus for the law. “State legislators are talking to their police chiefs, their EMS chiefs, school superintendents, going to funerals of people that have overdosed. State legislators are more in tune about what’s happening than anyone else.” They talked to family members and providers, and one of the things they learned was that because of insurance barriers, treatment was difficult to access. “The legislators wanted to do something to try to stop the carnage,” he says.

What insurance companies were telling patients was that they could be detoxed on an outpatient basis. However, when there’s no place for these patients to go after detox, the results can be disastrous, says DiGravio. Also “detox” in Massachusetts doesn’t necessarily mean withdrawal from opioids—it often means starting the patient on buprenorphine or methadone, he says.

The legislation also eliminates prior authorization requirements for detox, detox stepdown and medication-assisted treatment with methadone, buprenorphine or Vivitrol (injectable naltrexone), says DiGravio.

Commercial insurance companies, which traditionally haven’t covered methadone, have announced that they will, starting July 1, says DiGravio. However, daily copayments have made this unworkable in the past (many methadone patients go to the clinic almost every day to pick up medication). “We’re hearing anecdotally from our members that health plans are moving away from daily copays,” he says.

Another bill now being considered would require MassHealth (the state’s Medicaid program) to reimburse OTPs for buprenorphine and Vivitrol, as well as for methadone.

Increasing access to treatment is the main way to stop the opioid crisis, says DiGravio. “The only alternative is to have people who are literally dying,” he says. “We’re past the tipping point.”

Locating a facility

One problem Massachusetts does not have, compared to most other states, is siting a treatment facility. The NIMBY (Not In My Back Yard) issue does not pose a big problem, DiGravio says. “Siting is never an easy process, but it’s not on the top 10 list of barriers,” he says, adding that there are strong legal restrictions against communities prohibiting treatment programs.

Spectrum’s new program offers an example of innovation, says DiGravio. “Spectrum is using the private pay clients to help enhance the quality of treatment for publicly funded clients,” he says, noting that there will be 50 beds for publicly paid patients and 50 for commercial or private pay.