The opioid epidemic is not new and it’s not going away. It is a complex problem that tragically affects too many people. As a company, Tufts Health Freedom Plan has made it a priority to support our members, our employees, and the communities we serve who are struggling with opioid use.
It’s about going above and beyond providing good coverage for treatment.
This is about more than what’s covered and what’s not. To truly help our members, we’ve organized multiple teams in the company to study, analyze, and create effective care solutions for our members who are struggling with opioid addiction.
We’ve identified the most skilled behavioral health and substance use disorder experts who deeply understand the complexities of addiction and effective treatment, and placed them in roles that best position them to help members and providers coordinate effective treatment.
Our goal: help members access the right care, at the right time, in the best place.
“Our clinical programs are developed to help members get the services they need, and ensure those services are integrated with their medical treatment. We want to ensure social supports are mobilized to help members achieve their goals. Our goal is to give members the tools to build strategies for recognizing when they may need additional supports,” says Taverly Sousa, Manager of Behavioral Health Clinical Programs for Tufts Health Freedom Plan.
The data is critical to identifying members who might be using or struggling with addiction, so we can proactively reach out to those members and their providers to coordinate the right care approach.
“We look at what types of diagnoses drive readmissions, and the kinds of situations that our medical colleagues ask us for help with or consultations on,” says Sousa.
We created a role dedicated to helping addicted members
As the opioid epidemic has compounded, more and more members are calling us to understand treatment options and coverage.
To address this, we created the role of Substance Use Disorder Family Navigator, a position dedicated to helping members and their families understand addiction, treatment options, and benefits and coverage, and find solutions that fit their situation.
But what’s most important about this role, is a deeply nuanced understanding of substance use disorder.
“The nature of substance use disorder is iterative,” says James Patterson, the Substance Use Disorder Family Navigator at Tufts Health Freedom Plan. “Just because a person realizes they have a problem doesn’t mean they can apply the solution. It may take 1 or 2 or 3 more tries. Relapse behavior is not an indication of treatment failure or failure of commitment -- it is the nature of the disease.”
The navigator role complements the work of our Care Management Program, an outreach program designed to offer individualized support to members with various complex conditions, including substance use disorder.
And Patterson works collaboratively with our Medical Care Managers and members who may be using opioids, so members can be referred to the right services at the right moment.
That said, members have to be willing to engage with the navigators and care managers.
“But, we never stop calling and offering resources,” says Sousa.
We emphasize the importance of local care
The data speaks for itself: patients who are surrounded by their own physicians, behavioral care practitioners, and personal support systems have a better chance at successfully recovering from substance use disorder.
As a result, we’ve contracted with a broad network of substance use disorder facilities, programs, and practitioners, including:
- An ambulatory network, which has added more than 100 additional licensed alcohol and drug counselors over the past year
- Providers who specialize in and adhere to evidence-based practices in the care of substance use disorder patients
Critical coverage: a broad range of treatment options
We recently decided to cover the life-saving drugs Narcan and Naloxone injection at a $0 cost-share for all members. And last year we eliminated the member cost-share for methadone clinics for all commercial plans.
In addition, we’ve made sure our insurance products cover a broad range of treatment options, including coverage for:
- Inpatient detoxification and acute residential treatment
- Partial hospital programs and intensive outpatient programs
- Outpatient therapy and medication management
- Medication-assisted treatment, including methadone maintenance and prescription of Suboxone
- Pharmacy coverage for medications used to treat addiction, and for medications that can reverse an opioid overdose at no cost to members
Investing in “Zero Left”
Zero Left is a campaign with a three-pronged approach designed to stop addiction before it starts.
Picking up on this important work started by Jim and Jeanne Moser to combat the opioid drug crisis, Tufts Health Freedom Plan teamed up with Northeast Delta Dental to give a grant to Granite Health to prevent addiction and combat the crisis.
The grant makes it possible for Granite Health to install takeback boxes at 3 of its member facilities. And participating members of Granite Health have committed to distributing 15,000 drug destruction packets, which neutralize the active ingredients in opioids for safe in-home disposal of excess or expired medication.
Lastly, grant funding will provide specialized education and training on appropriate prescribing to medical providers and dentists.
Substance Use Disorder is a complex care challenge for everyone
Opioid use is at an all-time high and its impact can be seen across all the demographics and communities we serve.
For our members and their families, accessing and navigating treatment and supportive services is complicated and sensitive.
“Just because the problem is epidemic in proportion doesn’t mean it doesn’t also come with guilt, shame, denial, remorse, and all of those emotions that make it hard to treat,” says Patterson.
Treatment requires an approach that integrates expertise in substance use disorder, social work, and medical treatment. As an insurer, we at Tufts Health Plan are responsible for acting as a guiding resource and intermediary for our members, their providers, and health care facilities.
Our goal remains to be a trusted partner for our members, and to help them access the right care, in the right place as they need it.