Highmark Expands Partnership to Personalize Substance Abuse Care

Highmark Inc. (Highmark) has expanded its partnership with an end-to-end substance abuse care vendor, axialHealthcare, to better serve members in Pennsylvania with substance abuse care needs.

“Providing each member in need with a dedicated team, the program works with treatment providers to help coordinate care during critical transitions, connects members to social resources, and ultimately provides the dedicated, long-term support essential to sustained recovery,” the press release states.

The program will use personalization to help keep members in treatment. Providers will leverage coordinated care as well as peer support to provide continuity of care. By building a care team around individuals, the program aims to enable continuity of care through transitions and long-term recovery needs.

Data analytics will help guide the health plan’s coordinated care approach by using the platform to identify at-risk members, support treatment enrollment, and manage care costs.

“Our Highmark members can now be guided by individuals with lived experience in the recovery space, have a simplified care navigation experience, and access resources to remove non-clinical barriers to care,” says DeLeo.

The program extends an already existing partnership that started in 2018, targeting opioid overprescription and polydrug use as well as pursuing higher screenings for substance use disorders and more naxolone prescriptions to help manage overdoses.

Since starting the recovery program, opioid overprescription from more than one provider has dropped by 15 percent and co-prescription of benzodiazepines and opioids fell by a similar amount. Additionally, naxolone prescriptions have increased by 100 percent.

Overall, the payer has reduced opioid prescription by over 22 percent across commercial, Medicare Advantage, and Affordable Care Act marketplace members. Opioid-related overdoses among Highmark members are around half the national average, despite being based in states with some of the highest rates of drug overdose.

Payers have been working to stem the severe impact of the coronavirus pandemic and social distancing on members with substance abuse care needs.

Substance abuse can leave patients’ bodies more susceptible to coronavirus symptoms, according to the National Institute of Health. Plus, those with mental healthcare needs may fall back onto substance use disorders amid the isolation of social distancing. Meanwhile, the virus has obstructed access to clinical support to mitigate these conditions.

“This has been an extremely difficult year for individuals and families at all stages of recovery,” says Caesar DeLeo, MD, vice president and executive medical director of strategic initiatives for Highmark.

“COVID-19 has increased social isolation, stress and economic problems, while presenting additional hurdles in staying connected to or accessing treatment. Telemedicine expansion has been a great innovation and now we are adding to that peer support counselors through an expanded partnership with axialHealthcare.”

The effort to counteract these impacts must leverage strong partnerships.

For example, Tufts Health Plan, which serves Massachusetts, Rhode Island, New Hampshire, Nd Connecticut, partnered with Recovery Centers of America (RCA) in June 2020 as New England emerged from the first wave of the coronavirus.

By partnering with RCA, Tufts Health Plan gave members access to the organization’s two facilities in Massachusetts. The centers offer acute treatment services and medication-assisted treatment as well as more targeted support for LGBTQ+ and first responders with substance abuse care needs.

Highmark’s substance abuse care approach is not restricted to consumers.

The payer also has a grassroots, employee program that advocates for substance abuse care, reduced stigma, and a positive recovery culture within the company.

“There was a large response and individuals wanted to share how substance use disorders have personally affected them, their family, their communities, and people really wanted to be able to help,” Ashley Potts, senior project manager at Highmark, told HealthPayerIntelligence.

“It was really tapping into the energy of the folks who are in your own organization, who want to do something. And I think that was the secret sauce.”

Whether reforming the culture within a payer organization or seeking out new strategies to support members struggling with substance abuse care, partnerships and peer support are proving crucial to the coronavirus era substance abuse care response.