Issue link: https://nebusinessmedia.uberflip.com/i/873956
Insurance 'parity' for addiction treatment inadequate Drug Treatment By Danielle Morgan A mong the countless substance abuse patients I've worked with during my 17 years inside detox units, pain clinics and mental health centers, a patient whose story sticks out in my mind is someone I'll call Sally. I was called to triage to evaluate Sally, who was addicted to heroin and homeless aer leaving an abusive boyfriend. Staff said Sally was "combative and difficult" aer being told she could not be admitted to detox until her withdrawal was severe enough, according to her insurance policy. It takes a huge commitment to say "I am ready to make the change," stop your life, step into a treatment center, and be ready to embrace the change before you. To be told you don't meet the criteria to be in detox and getting angry at staff aer 26 hours in triage is an understandable and common response for a patient on the brink of this change. I explained this to Sally and we commiserated about our frustrations with the system. She vomited and approached the withdrawal score we needed to admit her. Sally had no job or access to transportation nor mental health medications. She needed "total case management" on day one. Before she was even awake in detox, her clinician had already started looking for a female bed in a treatment facility for aercare. We had four days le before insurance would no longer fund Sally's stay. With such a short amount of time, and a dearth of rehab beds in the state, we couldn't find her an accommodation. Her struggle is not uncommon for the addicted. ose seeking detox are oen required to wait hours or even days until they are sick enough to meet medical necessity criteria. is is emblematic of the disrespect, degradation, humiliation and loss of human spirit that the addicted person endures in both their own self perception and from the community around them. Medical providers who treat addiction also face an uphill battle, as they oen have only days to detox a patient, help schedule outpatient appointments, meet with family members, and sometimes, if possible, locate housing or employment. It's exhaustive work, whether it's in a detox unit or an outpatient pain clinic. Patients are oen in pain, angry and suffering psychiatric challenges to boot. If a pain clinic's medical staff refuses to prescribe the painkillers, addicted patients threaten to purchase the drugs illegally. We know very clearly that if we do not engage them adequately, they may leave, overdose and die. ough federal law requires "parity" in the treatment of addiction and mental health, in reality our healthcare system offers better care for chronic conditions like diabetes, asthma and heart disease. No disease carries the social stigma, legal consequences, or invites moral judgment like addiction, even though it is based in biology like any other illness. We get distracted by the behaviors surrounding addiction and we oen lose sight of the lost, sad and broken human being in need of more treatment and less legal trouble. While we understand addiction is more complicated to manage than other chronic conditions, we continue to fail to hold payer sources accountable to parity laws. Several bills that did not pass the legislature this year would have helped us in our fight against the opioid epidemic, including legislation that would have mandated longer detox and treatment insurance coverage. Our citizens will not recover from this disease, which happens to carry far-reaching social, legal, and economic consequences, until we commit to accessible health care for folks like Sally. Danielle Morgan is a family psychiatric nurse practitioner in private practice in New Haven and Guilford and a member of the medical staff at New Solutions Pain Management Clinic in Milford. Community health workers are worth the money Healthcare Systems By Patricia Baker T here are not many certainties in health care during these tumultuous times, but here are a few: • No matter what happens in Washington, there will be growing pressure on healthcare providers and insurers to control costs. • Providers will increasingly be held accountable for patients' outcomes. • Perhaps most importantly, there's a lot of room for improvement in the health of, and the care delivered to, Connecticut residents — particularly people of color. ese dynamics present challenges that are daunting, but not insurmountable. One of the key steps that healthcare providers, insurers and employers can take now is to embrace the use of community health workers as a critical and cost- effective way to improve health. Community health workers (CHWs) are public health workers who help to bridge the gaps between the doctor's office and patients' lives outside the clinic. CHWs can identify and help overcome barriers people face to taking care of their health. ey make sure patients show up for appointments, access the right care at the right time, have the tools to manage chronic conditions, and can access and afford their medications. ere are many CHWs in Connecticut, oen known by other terms, such as health coaches, patient navigators or peer educators. ey can oen be found working for hospitals, community health centers, behavioral health clinics and community-based organizations. CHWs can play a key role in reducing preventable hospitalizations and readmissions – something healthcare organizations will be under increasing pressure to do as payers shi their focus to care quality. While the Connecticut Health Foundation has provided more than $1 million in grants for CHW programs over the past 17 years, what's been missing is a way to ensure that this critical role can be funded in a sustainable way. We are eager to partner with healthcare organizations interested in pilot projects to test sustainable models. It could mean hiring CHWs to help diabetic patients get their blood sugar under control – reducing preventable hospitalizations, amputations and premature deaths – as the Mercy health system in Texas has done. It could mean using CHWs to help frequent emergency department users better address their needs, as the insurer Molina Healthcare did in New Mexico. In a recent report commissioned by the Foundation, researchers at the University of Massachusetts Medical School's Center for Health Law and Economics identified the above programs as having potential for Connecticut. ey are projected to produce savings in direct medical costs that exceed the cost of the program within three years. For example, the diabetes program, if implemented in Hartford to serve 316 people, would cost $388,000 and save an estimated $435,000. A new law, Public Act 17-74, puts Connecticut on a path toward certifying CHWs, a key step in ensuring they meet established standards. is can provide confidence to hospitals, physician practices, community organizations and insurers about the workforce. It's understandable that some healthcare organizations would be wary of spending money on an additional service when cost pressures are forcing cutbacks. However, we at the Foundation view CHWs as a worthwhile investment that will save money and improve health outcomes. Patricia Baker is the president and CEO of the Connecticut Health Foundation, the state's largest independent health philanthropy. H H GREATER HARTFORD HEALTH • Fall 2017 21