AmeriHealth Caritas District of Columbia Launches New Payment Model to Support Fully Integrated Treatment Strategies for Addiction Recovery

New pilot program with Howard University Hospital will incentivize a coordinated system of substance use disorder treatment and prevention

December 3, 2020 - Washington, D.C.

Washington, D.C. — AmeriHealth Caritas District of Columbia, a Medicaid managed care plan serving the District of Columbia and a part of the AmeriHealth Caritas Family of Companies, has collaborated with Howard University Faculty Practice Plan to pilot a new value-based payment model to promote integration of drug and alcohol addiction treatments to help keep patients in recovery and to reduce relapse.

Dr. Yavar Moghimi, medical director of Behavioral Health for AmeriHealth Caritas District of Columbia, said the objective of this pilot program – a value-based reimbursement strategy, introduced first between the Medicaid managed care organization and Howard University Faculty Practice Plan – is to incentivize services that promote sustained recovery.

“We are incredibly optimistic that this new payment model will increase the chances of addiction recovery for many of our members. The goal of the Addiction Recovery Medical Home Alternative Payment Model is to align incentives for patients, payers and health systems to facilitate an integrated, whole-person care model for addiction recovery, which includes a behavioral health component,” said Dr. Moghimi.

“The collaboration between payers and providers is essential in providing a continuum of care from addiction diagnosis through the recovery process. We believe this new payment model will help save lives, prevent unnecessary overdoses and connect members to addiction services,” he added.

Although addiction is a treatable chronic disease, it is often stigmatized. Such stigmatization leads to missed opportunities for early diagnosis, intervention, and provision of effective treatment. Racial and ethnic minority groups are most likely to experience barriers to substance abuse treatment, Dr. Moghimi said. One of the goals of this innovative addiction recovery payment model is to address disparities in care and help reduce addiction problems in vulnerable populations.

Dr. Richard Schottenfeld is professor and chair of the Department of Psychiatry and Behavioral Sciences at Howard University College of Medicine and Howard University Hospital. He noted that only a minority of people with substance use disorders receive treatment in the United States. This gap between the need for and receipt of treatment is particularly severe for Black Americans — and this is visible in the District of Columbia.

“The District has one of the highest rates of overdose deaths and has been experiencing the fastest increases in overdose deaths nationally,” Dr. Schottenfeld said. “Overdose deaths are highest among Black men in the District, yet Black Americans with opioid use disorder are 40 percent less likely than White Americans with the disorder to receive treatment.”

Dr. Schottenfeld said the innovative collaboration with AmeriHealth Caritas District of Columbia is an important step toward a population-based model for healthcare delivery, partly by encouraging early diagnosis and intervention and the continuation of follow-up treatment for those experiencing substance use disorders.

In response to a recommendation from the U.S. Surgeon General to develop integrated substance abuse services, AmeriHealth Caritas District of Columbia and Howard University Faculty Practice Plan joined other payers and health care providers in forming the Alliance for Addiction Payment Reform (Alliance) with the goal of creating a structure that promotes the type of integration and patient care capable of producing improved outcomes for patients, payers, and health systems long-term by aligning all incentives.

“It is not uncommon for patients fighting addiction to have other underlying health conditions, which are worsened by their addiction,” Dr. Moghimi explained. “A whole-person care model allows providers to support their patients’ overall well-being, implement preventative health measures to reduce overall health costs.”

Providers interested in learning more about Addiction Recovery Medical Home Alternative Payment Model may contact Dr. Yavar Moghimi, medical director of Behavioral Health for AmeriHealth Caritas District of Columbia, at 1-202-326-8992.