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AMA, ASAM announce new payment model to ‘revolutionize’ opioid use disorder treatment

Together, the AMA and the American Society of Addiction Medicine created a “groundbreaking” alternative payment model, or APM, that combines payment for medical and psychosocial services and aims to manage more patients with opioid use disorders successfully while decreasing spending on addiction-related costs, according to a press release.

“We have seen significant increases in the rate of individuals dying from opioid poisonings across the United States once again this year,” Kelly J. Clark, MD, president of ASAM, said in the release. “At the same time, millions of individuals across the country continue to lack access to treatment due to insurance reimbursement and coverage barriers. I am proud of the AMA-ASAM APM Working Group for developing a framework that seeks to address these issues.”

The new payment model, Patient-Centered Opioid Addiction Treatment (P-COAT), intends to provide appropriate financial support to allow for greater utilization of and access to medications for opioid use disorder, according to the release. P-COAT also seeks to expand coordination for the delivery of medical, psychological and social support services because medications combined with psychosocial supports effectively treats opioid use disorders, according to the release.

“Arbitrary limitations on effective, comprehensive treatment are stymying physician efforts to treat patients with opioid use disorder,” Patrice A. Harris, MD, chair of the AMA Opioid Task Force, said in the release. “This new tool will remove a brick in the wall that prevents patients from accessing needed treatment. Eventually, this wall will be torn down. Until then, we must continue fighting for our patients and remove arbitrary barriers to care.”

Phone calls, email consultations and other non-face-to-face services, as well as improved coordination between health care providers are critical in the treatment of opioid use disorders, according to the release. Therefore, the model also supports and facilitates coordination between multiple treatment providers, according to the release.

“The current physician reimbursement structure does not account for all the services that patients with an opioid use disorder need to progress to successful treatment and recovery,” Shawn Ryan, MD, chair of the AMA-ASAM APM Working Group and ASAM’s Payer Relations Committee, said in the release. “While we know that a combination of medication and psychosocial support systems is the evidence-based standard for treatment, we continue to find that patients are not able to access treatment due to limited or non-existent insurance coverage. We hope that today’s announcement will begin a national conversation with insurers and policymakers about what it takes for successful treatment and recovery.”

The AMA and ASAM are looking for physician practices and insurers to participate in pilot testing of P-COAT and urge those interested to sign up here.