AMA Issues Alternative Payment Model for Opioid Use Disorder Treatment

April 2018 ~

The American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM), on April 16, jointly announced plans to pilot test a model that includes medications combined with psychosocial support, and according to the announcement, the “groundbreaking alternative payment model (APM) could revolutionize how patients with opioid use disorder (OUD) are treated”.

The ASAM and AMA say the new model, known as Patient-Centered Opioid Addiction Treatment (P-COAT), has the potential to increase the number of patients with opioid use disorder who are able to lead satisfying, productive lives through successful management of their condition while also reducing health care spending on costs associated with addiction, such as emergency department visits and hospitalizations.

The new model has been designed to reduce costs, improve care, and increase utilization of and access to medications for the treatment of opioid use disorder by providing the appropriate financial support to successfully treat patients and broaden the coordinated delivery of medical, psychological and social support services. P-COAT is also intended to support office-based opioid treatment in order to facilitate coordination between multiple treatment providers.

The payment model consists of two types of payments for two separate phases of office-based opioid treatment. Practices that are part of Opioid Addiction Treatment Teams (OATTs) would be eligible to receive:

1. Initiation of Medication-Assisted Treatment (IMAT) – One-time payment to support evaluation, diagnosis, and treatment planning for a patient with an opioid use disorder and the initial month of outpatient medication-assisted treatment for the patient. This payment would be adequate to cover the costs of these services and would be significantly higher than monthly payments for ongoing treatment (MMAT).
2. Maintenance of Medication-Assisted Treatment (MMAT) – Monthly payment to provide or coordinate the provision of ongoing outpatient medication, psychological treatment, and social services to a patient who has successfully initiated treatment for an OUD. Monthly payments could continue if the patient was determined to be appropriate for continued therapy. This payment would be adequate to cover the costs of these services.

“We have seen significant increases in the rate of individuals dying from opioid poisonings across the United States once again this year,” said Kelly Clark, president of ASAM. “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 ASAM and the AMA are seeking physician practices and insurers interested in pilot testing the new payment model. Those interested in participating can submit their contact information through the P-COAT Interest Form.

For more information, see ASAM’s issue brief and find the complete P-COAT APM, here.

Source(s): Healthcare Payer News; Healthcare Finance; American Medical Association; Healthcare Informatics; RevCycleIntelligence;