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AMA unveils alternative payment model for the treatment of opioid use disorder

AMA and the American Society of Addiction Medicine are preparing to pilot test a model that includes medications combined with psychosocial support.

Susan Morse, Senior Editor

The American Society of Addiction Medicine and the American Medical Association announced a new alternative payment model and are seeking physicians and insurers interested in joining a pilot test for the treatment of opioid use disorder.

The alternative payment model pays for care that includes medications combined with psychosocial support, the most effective means of treating opioid use disorder, the AMA and ASAM said. 

The concept APM, called the patient-centered opioid addiction treatment, or P-COAT, broadens the coordinated delivery of medical, psychological, and social support services, according to the announcement by the AMA and ASAM on Monday.  

This includes non-face-to-face services – such as phone calls and email consultations with patients – in addition to better coordination between specialists, outpatient treatment programs and other health providers such as emergency rooms.

The model supports office-based opioid treatment. 

The current physician payment system offers little in the way of coordinated behavioral, social and other support services, the agencies said. Payment has been segregated, which contributes to patient difficulties receiving comprehensive care.

P-COAT provides the financial support to increase the number of patients who are able to successfully manage their condition while reducing healthcare spending on costs associated with addiction, such as emergency department visits and hospitalizations.

"Arbitrary limitations on effective, comprehensive treatment are stymying physician efforts to treat patients with opioid use disorder," said Patrice Harris, MD, chair of the AMA Opioid Task Force. 

Millions of individuals lack access to treatment due to insurance reimbursement and coverage barriers, according to Kelly J. Clark, MD, president of ASAM.  

"The current physician reimbursement structure does not account for all the services that patients with an opioid use disorder need to progress to successful treatment and recovery," said Shawn Ryan, MD, chair of the AMA-ASAM APM Working Group and ASAM's Payer Relations Committee. "While we know that a combination of medication and psychosocial support systems is the evidence-based standard for treatment, we continue to find that patients are not able to access treatment due to limited or non-existent insurance coverage."

The new model is being rolled out as legislators consider opioid measures, including a draft proposal by the Senate Committee on Health, Education Labor and Pensions.

HELP Chairman Senator Lamar Alexander said the bill would, among other initiatives, require opioids to be dispensed in smaller quantities of blister packs to limit the supply, increase data sharing among federal agencies, allow for telemedicine prescribing and move towards the use of non-addictive painkillers.

HELP is scheduled to mark up their opioid bill on Tuesday, April 24 prior to presenting it to Majority Leader Mitch McConnell later this month, according to Politico.

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