How Peer Recovery Increases Medication Adherence, Lowers Spending

Update 02/21/2020: This article has been updated to reflect that Blue Cross Blue Shield of Rhode Island partnered with the Anchor Recovery Community Center (a program of The Providence Center) to launch the peer recovery program. A previous version implied that the program belonged to BCBSRI.

Blue Cross Blue Shield Rhode Island (BCBSRI) is using peer recovery to combat the opioid epidemic. Recent data shows that the payer’s approach is having a positive impact on treatment and medication adherence, as well as healthcare spending.

Although opioid overdoses nationally fell by 2 percent from 2017 to 2018, the small state of Rhode Island saw 277 citizens die from an opioid-related overdose in 2017, according to the National Institute on Drug Abuse. That amounts to nearly 27 deaths per 100,000 people. In contrast, the national average is 14.6 deaths per 100,000 people.

Historically, these deaths have been concentrated in the area surrounding the capitol city of Providence, where the death rate for the past five years averages out to almost 45 deaths per 100,000 people—more than triple the national average.

BCBS Rhode Island was tackling the epidemic from the traditional angles: outpatient services, inpatient services, and intermediate programs. It encourages primary care providers to get involved and be on the lookout for substance abuse disorders.

BCBSRI also covers medication-assisted treatment (MAT), as recommended by Medicaid directors in Manatt Health’s recent toolkit. 

These interventions were having a positive impact: Since 2014, BCBSRI has reduced opioid prescriptions by 25 percent, a key step in reducing the opioid crisis as a whole.

"But over the past decade, we've started to really be more innovative and think—what do our members really need and how do we get to them?” Sarah Fleury, BCBSRI manager of behavioral health, explained. “We've just really been looking across the board at all sorts of different innovative things we can put into place to help our members.”

So the payer adjusted its payment strategies to allow for bundled payments and it piloted new benefits for substance abuse care.

But bringing in patients and keeping them in treatment remained a problem. To overcome this barrier, BCBSRI turned to peer recovery programming.

Fleury and her team had heard about peers being used by private and public payers in the emergency room to help a patient recover from an overdose and outside of the outpatient setting while patients were reacclimatizing to society.

“Peers were sometimes much more successful at getting people into treatment and staying in treatment than anyone else,” Fleury had heard. “More successful than family members, more successful than their primary care doctors.”

Peer recovery programs are grounded in the recognition that it takes a community to fight addiction. 

Stigma is one of the major barriers preventing patients from accessing substance abuse care. In a society that still associates substance abuse and rehabilitation with shame, peer recovery coaching can motivate patients to move forward with their treatment.

“Peers are a great way to help people overcome stigma,” Fleury said. “Peers are out in the community. They're talking about living in recovery. They’re not ashamed of being in recovery. They're able to show people with substance use disorders that a life after a substance use disorder is possible and that you can have a really fulfilling life with a career and family and love.”

With all of this in mind, BCBSRI partnered with the Anchor Peer Recovery Coaching Program, offered through Providence Center.

Headquartered on the edge of Providence, with other locations in the state as well as mobile access, Anchor’s Peer Recovery Coaching Program advances a peer recovery strategy to facilitate treatment and medication adherence for patients struggling with substance abuse.

For the study, BCBSRI members who had substance abuse disorders may have been referred to the peer recovery program by a provider, an emergency department visit, an inpatient caregiver, or took the initiative to submit themselves to the program. 

From there, BCBSRI members were connected with counseling opportunities and a social support network as they recovered from substance abuse. This could take the form of employment assistance, wellness programs, AA meetings, and more.

Through all of these facets of the organization, members gain a support network of people who have overcome substance abuse and others who are facing similar circumstances.

Looking at three years of member data, BCBSRI has found that this decision to move into peer recovery programming paid off, both figuratively and literally.

Fifty percent of the study’s participants combined their peer recovery programming with MAT. Those with that combination were 65 percent more likely to continue with treatment.

Primary care providers proved critical to getting members into treatment. The study showed that participants who had a PCP were 73 percent more likely to start treatment.

Despite being centralized in an area where around 50 percent of well-documented, opioid-related deaths (approximately 48.8 percent) from 2014 to 2018 were between the ages of 25 and 34, the BCBSRI-Anchor peer recovery program saw higher MAT participation in younger people with a mean age of 33.

The program also resulted in healthcare savings. Members’ medical and pharmacy costs dropped by 12 percent after starting the program.

BCBSRI predicts that members who stay in the program could see a 67 percent decline in long-term healthcare costs.

“We are encouraged by these results, but we also know we still need to focus on connecting more people to treatment and making sure they stay connected to treatment,” said Fleury in the press release. “These results give us a clear path to continue our efforts to encourage MAT and helping connect participants with a primary care provider if they don’t already have one.”

Attracting members to treatment programs and getting them to stay involved will not be completely solved by one program, however.

Fleury stressed that the BCBSRI has a number of strategies to increase awareness and get members into peer recovery.

“Our customer service agents know about the programs that are available. Our case managers know. We go out into the community to make sure that people working in the emergency rooms, in crisis centers, in doctors' offices—anyone that might come into contact with a Blue Cross member—that they know all of the services that are available to Blue Cross members,” she said. 

“So anyone that might have a conversation with the member, anyone that the member is comfortable talking to, has those resources available and is able to help that member access the care they need,” she added.

For now, the payer and provider do not foresee any major changes to the relationship or methodology.

As payers continue to explore ways to stem the opioid crisis, data regarding peer recovery’s uses and success rates like BCBSRI’s study will help guide payers’ peer recovery programs designs and implementation. 

In the meantime, Fleury said, payers can draw encouragement from the higher rate of program entry and the long-term savings associated with the BCBSRI-Anchor peer recovery program.