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Health Insurance Can Change the Way Substance Use Disorder is Being Treated – And That’s a Good Thing

Douglas Tieman | October 3, 2019

Health Insurance Can Change the Way Substance Use Disorder is Being Treated – And That’s a Good Thing

We took a big step, one we hope will eventually improve addiction treatment across the country for all patients, not just those at Caron. Caron is now an in-network provider of substance use disorder treatment with Highmark Blue Cross Blue Shield, making our Pennsylvania residential inpatient program accessible across the United States to those whose insurance is part of the Blue Cross Blue Shield Association’s Blue Card Program.

It really shouldn’t be news that a leading healthcare provider like Caron now takes health insurance, but it is.

In 2001 Caron stopped taking major health insurance contracts because we felt the insurance industry was on the wrong path in treating addiction, one that didn’t serve patients. The insurance industry is now starting to change, and that is a big deal.

Why we stopped taking insurance
In 2001, Caron stopped taking insurance because the managed care guidelines the insurance companies put in place for addiction treatment would not allow us to determine how much or how long we could provide care. In addition, we found that when we followed the managed care protocol, people relapsed at a higher rate.

Being a nonprofit organization gave us the freedom to make the risky and revolutionary decision not to take healthcare insurance. Instead, we committed to providing a level of care that was so good people would be willing to pay for it on their own, with means-based “scholarships” available to help make up the difference if someone couldn’t afford to pay the full amount. The change worked very well, for our patients who received the highest level of quality care. Above all, people wanted to get well - and our outcomes show that they did.

But the world has changed since 2001. The Affordable Care Act (ACA) now requires insurance companies to pay for addiction treatment. The Mental Health Parity Act means that insurance companies also couldn’t put unusual restrictions around treatment of substance use disorder. Finally, consumers – rightfully so - have come to expect insurance to cover addiction treatment.

At the same time, the ACA created the concept of accountable care organizations, which made insurance companies much more concerned about a participant’s total healthcare costs. Insurers became aware that, if they don’t take care of mental health now, it will cost them more in acute healthcare later. Insurance started to realize that they needed to identify better ways to address the treatment for substance use disorder.

There is also a growing understanding that substance use disorder is a chronic brain disease, one that must be managed daily for the long-term. This understanding is changing how treatment is delivered, and paid for, in this country. Enlightened insurance companies are now supporting patient-centric treatment that focuses on outcomes using evidence-based treatments – including supporting a 28-day length of stay.

Caron has been involved in a three-year pilot program with a major insurance company, where the company paid for individualized and longer treatment regimens. The results speak for themselves. Their utilization data showed that their members treated at Caron had readmission rates lower than those treated at other local facilities. Taking the time to treat someone right, the first time, means a better chance at lifelong recovery, a far lower risk of relapse, and lower healthcare costs in the long-term.

Other insurance companies have heard about Caron’s results, and they now want to be part of our network. Instead of dictating how we treat patients, these new insurance agreements enable the experts at Caron to dictate how care is delivered.

Quality of care is paramount
This all goes back to our mission: Recovery for life. Whether you’re being funded by insurance, funded with financial assistance or funded by a self-pay program -it really doesn’t matter what your financial access point is to Caron. We’re here to help individuals and families struggling with substance use disorder. The reason we stopped taking insurance in 2001 was because we refused to compromise our care . The same holds true today.

Taking insurance makes Caron more accessible to more people, one of the core pillars of our long-term strategy. There is such a need. We hope that by making this change, affordability will not be as much of a barrier to treatment at Caron. We will continue to offer financial assistance. In fact, we’ve allocated more funds for financial assistance this year than last year. We hope to provide more financial assistance to those people who don’t have insurance or don’t have the right kind of insurance. In addition, because of our agreements for primary treatment, we can use financial assistance to cover programs such as My First Year of Recovery, extended care, Caron Renaissance, and other programs at Caron that are not covered by insurance.

What this means for the treatment sector in general
It is my hope that this announcement jumpstarts a major change in the way insurance companies and providers approach the treatment of substance use disorder. There was a lot of skepticism about Caron refusing insurance in 2001, but within five years they were all asking how we were able to increase our clinical rigor, improve outcomes for our patients, and increase our investment in addiction research, education and prevention. I anticipate a similar reaction this time. Insurers are already asking us for the “secret ingredient” to getting these kinds of outcomes, and, as a nonprofit, we’re willing to share what we do. We want individuals and families struggling with substance use disorder to get well.

We consider ourselves a laboratory for what can be done. The reason other providers often don’t have the level of care that we have is because they can’t afford to do it. If we’re able to demonstrate to the rest of the sector that putting more time and resources at the front end will provide a higher level of care, better outcomes, and a more stable income stream long-term, I think that will be very attractive to many facilities.

Ultimately, one of our goals is for this illness to be treated no differently than any other chronic illness, a change that would have ripple effects throughout the entire healthcare system and which would better serve patients. The willingness of insurance companies today to reimburse Caron for patient-centric care, where Caron experts are making decisions in the best interests of the patient, shows that we have come a long way in understanding addiction is a chronic disease.

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