The American Society of Addiction Medicine and the American Medical Association have developed an alternative payment model for the treatment of opioid use disorder.
Here are six things to know about the payment model, called P-COAT.
1. P-COAT, revealed Apri1 16, is designed to reduce costs and improve care associated with opioid addiction through appropriate financial support. It also aims to improve care coordination between providers.
2. Various insurance reimbursement and coverage obstacles have limited access to treatment for patients with opioid use disorder, according to a concept paper on P-COAT authored by the organizations. For example, most payers don't reimburse for transportation, housing or other non-medical services related to patients' addiction treatment. The AMA and ASAM also noted challenges created by the complexity and continued changes with billing for substance use disorder services, among other issues.
3. According to the paper, these obstacles and others result in increased healthcare and societal costs. The AMA and ASAM said this is partially due to frequent hospitalizations and longer hospital stays among opioid use disorder patients without access to effective treatment.
4. P-COAT aims to eliminate reimbursement and coverage barriers through various means, such as providing appropriate financial support for successful medication-assisted treatment and encouraging more primary care practices to provide MAT, according to the ASAM and AMA.
5. The payment model consists of two types of payments for phases of office-based opioid treatment — initiation of MAT and maintenance of MAT. The former would support services such as evaluation, diagnosis and treatment, as well as initial outpatient medication-assisted treatment. The latter would support ongoing outpatient medication, psychological treatment and social services.
6. The ASAM and the AMA said they are looking for physician practices and insurers to participate in pilot testing P-COAT. Interested parties can provide their contact information here.
The full payment model language is available here.
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