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Group of payers say they will adhere to evidence-based principles

November 8, 2017
by Gary A. Enos, Editor
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A substance use treatment task force that was launched last spring has secured a commitment from a group of 16 payer organizations to promote addiction treatment services that are aligned with research-backed national principles. Several senior executives from prominent insurers are represented on the Substance Use Disorder Treatment Task Force, which made the announcement on Wednesday.

Among the payers committing to adopting the eight National Principles of Care derived from the Surgeon General's Report on Alcohol, Drugs and Health are national players Aetna, Cigna and UnitedHealth Group, along with regional entities such as Blue Cross Blue Shield of Massachusetts, CareOregon and Horizon Blue Cross Blue Shield of New Jersey. The Substance Use Disorder Treatment Task Force was co-founded by Shatterproof CEO Gary Mendell and Treatment Research Institute chairman Thomas McLellan, and includes representatives from government, medicine, the research community, public policy and the insurance industry.

“For the first time in history, leading healthcare insurers and other third-party payers from across our nation have come together and agreed to identify, promote, and reward one core set of evidence-based principles for addiction treatment,” Mendell said in a news release.

The eight National Principles of Care are:

  • Universal screening for substance use disorders across medical care settings (to be followed by clinical guidance, family education and regular monitoring when needed).

  • Personalized diagnosis, assessment, and treatment planning.

  • Rapid access to appropriate substance use disorder care (because “periods of motivational readiness rarely sustain,” states the rationale for this principle).

  • Engagement in continuing long-term outpatient care with monitoring and adjustments to treatment.

  • Concurrent, coordinated care for physical and mental illness.

  • Access to fully trained and accredited behavioral health professionals (with some of the suggested effective therapies in this area including cognitive-behavioral therapy, family/couples therapy and motivational enhancement therapy).

  • Access to FDA-approved medications.

  • Access to non-medical recovery support services (including peer and community services).

“These National Principles of Care are furthering the goal of putting substance use disorders on the same plane as other chronic illness,” said Mary Ann Christopher, vice president of clinical operations and transformation at Horizon Blue Cross Blue Shield of New Jersey.

Organizations represented on the task force realize that putting these principles into actual practice will be challenging, however. “The payers on this task force have taken a key step by agreeing to incorporate these evidence-based principles of care into their programs,” said Pew Charitable Trusts senior director of health programs Allan Coukell. “But implementing the needed changes will not be easy; we must all work together—with urgency—on the next steps, which include broader engagement with the wider stakeholder community.”