How Insurance Can Help Families Facing Addiction

By Gerri Vaughan, President of Tufts Health Freedom Plan

The time is right for employers to take the lead on navigating treatment and supportive services on behalf of their employees. While traditionally mental health and issues related to substance use disorder were not discussed in the workplace – often carrying a stigma of unreliability and unemployability – employers can play a critical role in early identification and intervention through employer-sponsored health benefits designed to treat substance use disorder.

The opioid epidemic has torn families apart and is an incredibly challenging issue to address. Although navigating this disease can seem complicated and unmanageable at times, a trusted insurer is part of the solution that enables employers to seek out and identify the help and care they need for their staffs and their families.

Young adults are a demographic at particular risk, leaving parents struggling in search of help. Equipping parents with the information they need to support recovery with a seamless and integrated approach to care improves medical outcomes for their loved ones who are struggling.

One example is for businesses to work with their health plan to help provide access to locally-based treatment centers. Unlike the costly, out-of-state alternatives, local treatment allows for recovery in a familiar environment, where learning to cope with triggers, rather than avoiding them, happens throughout recovery. Local treatment also provides an easier transition back to the community including the plan for a person's return to their professional and personal life.

Treatment also requires an approach that integrates medical and behavioral health expertise. Insurers are uniquely positioned to act as a guiding resource and intermediary and many are appointing staff to act as a guide for patients and caregivers to assist in navigating the resources available.

For instance, in 2016 Tufts Health Freedom Plan created a new position to help members and families approach addiction treatment: The Substance Use Navigator. Complementing the work of our care management program, the Navigator helps members and their families understand treatment options, benefits and coverage, make decisions about next steps, find resources available to them and find solutions that fit their situation on a case-by-case basis. The Navigator's personalized attention allows members to capitalize on the spectrum of treatment options.

Another way businesses can help their employees and their families is to help ensure access to medication-assisted treatments. Tufts Health Freedom Plan has also created a unique program to encourage behavioral health and primary care providers to prescribe Suboxone as a medication assisted treatment by offering providers reimbursement for the federally mandated training. The goal of this program is to increase access to a critical treatment.

Education of providers is also key. Tufts Health Freedom Plan and Northeast Delta Dental are collaborating to improve safe prescribing practices and to promote alternative treatments through messaging to all dentists. We also worked to train 30 dentists and 80 providers in the SCOPE of Pain program last year. Initiatives like this are critical because, as a 2011 study in the Journal of the American Dental Association indicated, dentists are responsible for 12 percent of prescriptions for fast-acting opioid pain relievers.

We can’t do this alone. It is also imperative to work with community groups focused on this issue. That is one of the reasons we partnered with the Zero Left Campaign, which aims to stop substance use before it starts. Last year we provided the organization with a grant which aims to reduce excess prescription opioids. The funding helped to install drug takeback boxes throughout the state, provided destruction packets, which neutralize the active ingredients in opioids for safe in-home disposal , and worked to ensure education on appropriate prescribing for local physicians.

The integrated approach across primary care, behavioral health, inpatient and community providers, supported by insurers, connects patients with services close to home and the team-based attention necessary for long-term control of substance use disorder.