Integrated Health at Core of New Opioid Addiction Payment Model

A new alternative payment model drafted by the American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM) seeks to improve opioid care by integrating medical care, addiction support, and psychiatric services.

“We have seen significant increases in the rate of individuals dying from opioid poisonings across the United States once again this year,” Kelly J Clark, MD, MBA, DFAPA, DFASAM, president of ASAM, said in a press release announcing the new payment model. “At the same time, millions of individuals across the country continue to lack access to treatment due to insurance reimbursement and coverage barriers.  I am proud of the AMA-ASAM APM Working Group for developing a framework that seeks to address these issues.”

The new payment model, called Patient-Centered Opioid Addiction Treatment (P-COAT), aims to improve the care of patients with opioid misuse disorder. The AMA noted that the plan will also decrease health costs commonly associated with opioid addiction, including ED visits, hospitalizations, and critical care.

The model will integrate addiction care within the office setting by supporting collaboration between medical, psychological and social support services. The model will also allow for better integration and collaboration between multiple treatment providers. In the past, reimbursement for these services have been fractured—which the AMA noted has led to difficulty receiving comprehensive care.

Additionally, PCOAT will increase access to medications for the treatment of opioid misuse disorder by providing financial support. The model also aims to reduce spending on unnecessary outpatient services that don’t really help patients with opioid addiction. The model supplements these wasteful services by providing evidence-based outpatient care for patients discharged from intensive levels of addiction care.

“Arbitrary limitations on effective, comprehensive treatment are stymying physician efforts to treat patients with opioid use disorder,” said Patrice A Harris, MD, MA, chair of the AMA Opioid Task Force, said in the press release. “This new tool will remove a brick in the wall that prevents patients from accessing needed treatment. Eventually, this wall will be torn down. Until then, we must continue fighting for our patients and remove arbitrary barriers to care.”

—David Costill

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