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Anthem Inc. Sets Aggressive Goals to Help Prevent Addiction, Increase Access to Care

ELV | January 18, 2017

Anthem Inc. Sets Aggressive Goals to Help Prevent Addiction, Increase Access to Care

Affiliated health plans aim to double number of members getting counseling

More people in the United States are suffering from opioid addiction and dying from overdose than ever before. Anthem, Inc. has been identifying ways to help consumers better access treatment while also putting into place policy changes that help reduce opportunities for addiction.

To help ensure consumers have access to comprehensive evidence-based care, Anthem is committed to helping its affiliated health plans double the number of consumers who receive behavioral health services as part of medication-assisted therapy for opioid addiction. To address the continued overuse of opioid prescriptions, Anthem affiliated health plans aim to reduce the amount of opioids dispensed among their members by 30 percent from historic peak levels by the end of 2019.

“Untreated opioid use disorders put consumers at increased risk for experiencing a number of medical issues, including overdose, infectious diseases associated with intravenous drug use, and death,” said Anthem Chief Clinical Officer Dr. Craig Samitt. “Making improvements with coordination and integration of medical and behavioral health care is an important factor to consider in efforts to mitigate these medical risks. Health insurers can and should play a strong role in making changes to improve the lives of their members.”

For the last year, a large group of Anthem medical directors, nurses, pharmacists, care managers and benefits experts have been working closely together to re-examine policies and determine how Anthem affiliated health plans can do their part to help prevent addiction and provide greater access to care.

Anthem’s internal research of member claims with medical and pharmacy benefits demonstrated that its health plans’ members aren’t getting the best practice combination of behavioral health and drug therapy to combat addiction. Of those who received buprenorphine products, only about 16 to 19 percent of the members taking MAT medications for opioid use disorder also were getting the recommended in-person counseling.

To address these findings, last year three Anthem affiliated health plans in the northeast began rolling out standardized MAT therapy coding for both psychiatrists and non-psychiatrist MDs certified to support MAT treatment to maximize their reimbursement and make reimbursement consistent for subsequent visits. In addition, Anthem is working to connect non-psychiatrist MDs to behavioral health support to help ensure members get counseling while receiving their drug therapy. These efforts will be extended to all Anthem affiliated health plan states by early 2018.

To further increase access to care, Anthem affiliated health plans recently removed their prior authorization that was intended to help ensure clinically appropriate use including that the member was enrolled in comprehensive counseling services for those receiving oral buprenorphine. In addition, all of Anthem’s individual and employer, and government-sponsored health plans have been implementing quantity limits on short and long-acting opioids to help prevent addiction.

“It’s incumbent on us to evaluate our programs and policies on a continuous basis and determine whether they are positively impacting our members,” said Sherry Dubester, Anthem vice president of behavioral health and clinical programs. “We are committed to making changes and discovering other ways to better solve for these health care issues.”

“Population-wide addiction is not something that is resolved within a year or two,” said Samitt. “We will continue our efforts and collaborate with others to create an environment that provides access to appropriate treatment and reduces addiction.”

About Anthem, Inc.

Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 73 million people served by its affiliated companies, including nearly 40 million within its family of health plans, Anthem is one of the nation’s leading health benefits companies. For more information about Anthem’s family of companies, please visit www.antheminc.com/companies.