After noticing a large uptick in claims for addiction treatment services, including expensive emergency room visits, CareFirst BlueCross BlueShield administrators said Wednesday that the insurer was developing a comprehensive method of caring for its customers.
The effort was announced by the state’s largest health insurer during an event at Baltimore City Hall, along with a plan to provide $1.5 million to nonprofit groups in the region to curb an opioid epidemic that has ravaged the city in particular.
“We cover in Maryland 2 million people, and about a quarter have some experience with prescription opioids and thousands are at risk of addiction,” said Chet Burrell, CareFirst’s president and CEO. “We found that people were calling into us from all walks of life, and they were struggling to get access to a provider.”
Burrell said CareFirst is building a network of clinics and providers who can treat substance abuse and mental health problems on demand. But the company isn’t only waiting for calls from its members. It has hired nurses and behavioral health workers and stationed them around its coverage area in Maryland, Washington and Northern Virginia to intercept people at the hospital or in doctors’ offices and direct them to appropriate treatment. Often drug and mental health treatment is needed in concert.
The insurer will waive co-payments and deductibles for those who agree to a specific treatment plan.
The move is the latest from public and private health care providers to curb the opioid epidemic that continues to worsen locally and nationally. President Donald Trump recently declared the epidemic a public health emergency and is seeking ways to implement recommendations, including expanding access to treatment, from the President's Commission on Combating Drug Addiction and the Opioid Crisis. The state and city have also taken steps that include training people to use the overdose reversal drug naloxone and making it available without a prescription, beefing up addiction hotlines and educational programs and seeking more treatment opportunities.
Doctors locally and nationally have been pushed to follow more stringent opioid prescribing guidelines set by the U.S. Centers for Disease Control and Prevention, as powerful painkillers such as oxycodone and morphine have proved to be highly addictive and a gateway to illegal opioids such as heroin and fentanyl. Doctors in every state are now obligated to check local prescription drug-monitoring programs that track how many opioid prescriptions people receive so they can’t “doctor shop.” Burrell said CareFirst has been monitoring its own doctors to ensure they are not unintentionally or purposefully overprescribing medications.
Still, overdose deaths from opioids continue to mount. State figures show that there were 1,172 deaths from alcohol or drug intoxication statewide in the first half of the year, with the bulk related to opioids. Baltimore had 393 fatal overdoses during that time, the highest number for any Maryland jurisdiction.
Burrell said it would likely be another year or year and a half before members could get on-demand treatment. And he couldn’t say how much the effort would cost, though he anticipated eventual savings by keeping people out of emergency rooms. Such visits cost an average of $1,500, and hospital stays cost an average of $25,000 to $30,000. CareFirst has already reduced emergency visits in recent years by better coordinating primary care for its consumers with chronic medical conditions.
On the mental health side, the insurer has to line up more psychiatrists, since many of them are not always willing to eschew their cash-only businesses and participate in an insurance network. CareFirst also needs to get commitments from more addiction treatment facilities. It already has five partners in the network with 13 treatment locations around the region, including six belonging to Kolmac Outpatient Recovery Centers.
Dr. George Kolodner, Kolmac’s chief clinical officer, said proper care involves ongoing support and not just detox and immediate treatment. CareFirst has agreed to continue reimbursements for a year for follow-up care.
The efforts won praise from Mayor Catherine Pugh and other city leaders at Wednesday’s announcement for seeking to provide better access to addiction treatment, as well as offering grants for nonprofits. CareFirst plans to assemble a panel of experts who can solicit and choose from treatment efforts. Burrell said they would provide seed money for some kind of innovation, like a combination of drugs or a treatment scheme that worked better than what’s now available.
For example, CareFirst has funded pilot programs in the past that tested whether an underused but government-approved blood test could detect prostate cancer as well as a more invasive and costly biopsy. CareFirst now pays for that test.
“We can’t do this alone,” Pugh said of fighting the opioid addiction epidemic. “This is a problem not just in the city, but in the state, surrounding jurisdictions and nationwide. ...This is a health crisis.”