Untimely deaths. A few years back, I received a Facebook friend request from a childhood acquaintance. I was busy at the time and not very active on Facebook, so I did not connect with him. I came to regret that small decision sometime later, when I discovered he was battling opioid addiction and had committed suicide. He needed a friend and treating opioid addiction is a community effort.
As time ticks by, I hear about other childhood friends who overdosed and died. The opioid epidemic is ugly.
An uphill battle. According to the Centers for Disease Control, 128 people die every day in the United States from opioid overdose. As expected, COVID-19 is making the situation much worse by way of massive unemployment, loss of employer-based health coverage, widespread mental health decline, and impacted mental health service delivery. Treating opioid addiction is no small feat, and the public health community believes a highly personalized approach, centered on medication assisted treatment (MAT), is the way to go.
To that end, the Centers for Medicare and Medicaid Services (CMS) will kickstart a new program in 2021 that aims to increase access to treatment, improve health outcomes among people battling addiction, and lower spending. The program is called Value in Opioid Use Disorder Treatment, or Value in Treatment (ViT) for short, and it will focus on the use of MAT to drive better health outcomes.
Additionally, CMS is promoting the use of a flexible care team to manage patients with opioid use disorder. Care teams can be made up of doctors, counselors, community health workers, care managers, licensed clergy, and peer specialists. CMS is also allowing telehealth for OUD care delivery, like mobile outreach and virtual doctor visits. Essentially, it takes a village to battle addiction, and CMS is adopting a more holistic, patient-centric approach.
Value in Treatment is a temporary program that will run for about 4 years. The goal is to measure health outcomes and overall spending to see if the entire program, or pieces of it, should be permanently covered under Medicare.
Under Value in Treatment, one big advantage to Medicare patients is that cost-sharing is waived. Medicare cost-sharing is no small thing, and it can deter patients from getting the care they need. Normally, there’s a $140 Part B premium and a 20% Part B coinsurance, but Medicare patients enrolled in ViT will not have to pay out-of-pocket for addiction treatment. See this page for more details on Medicare cost-sharing.
Innovative programs like Value in Treatment is the reason I favor straight Medicare versus Medicare Advantage. See my post on this topic for more details. However, it’s important to stress that ViT is a demonstration and not all Medicare patients suffering from opioid addiction will get access to the program.
There are two main focus areas to combat the opioid epidemic. The first is addiction treatment and recovery, which is the purpose of ViT. The second is reducing the onset of opioid addiction by regulating opioid prescriptions. Managing pain with opioids is a direct avenue to opioid use disorder. CMS is working to prevent future addictions by expanding access to alternative treatment options for pain. You can see this post for more details on CMS’ coverage for acupuncture, starting in 2020.
How might ViT benefit you? If you or someone you know is suffering from opioid addiction and is currently covered by Medicare, ask your healthcare provider about ViT and how you might get enrolled (please know that not all providers will participate in ViT). At the very least, you might save money by avoiding Part B cost-sharing.
The future of opioid treatment. Personally, I’m looking forward to CMS’ flexible approach to care teams and how that might reveal best-in-class approaches for treating opioid addiction. You can read more about ViT on this CMS website, but make sure to check back regularly since this page will probably be updated a few times per year.
~ James
