Tufts Health Plan Expands Substance Abuse Care Coverage

Tufts Health Plan is improving its coverage for substance abuse care for both commercial and government Tufts Health Plan members through a partnership with Recovery Centers of America (RCA).

“Our goal is to always provide our members with high quality, accessible care, close to their homes," said Emily Bailey, vice president of behavioral health at Tufts Health Plan. “Creating this relationship with RCA was very important to us because it not only expands our network, but it also helps us continue to serve our members suffering from substance use disorder as well as their families with a treatment plan tailored to their needs.”

Tufts Health Plan serves Massachusetts, Rhode Island, New Hampshire, and Connecticut and covers 1.4 million members. Since RCA has two facilities in Massachusetts—one closer to Boston and one closer to the center of the state—Tufts Health Plan said that members will have better access to in-network substance abuse care wherever they live.

The program treats patients all along the spectrum in their journey to wellness. From acute treatment services and clinical stabilization services to outpatient and medication assisted treatment, the centers assist relapsed patients, older adults, and more specific demographics such as the LGBTQ+ community and first responders fighting addiction.

“We are excited about our new relationship with Tufts Health Plan as it provides many of their members with access to nearby affordable addiction treatment that is vitally needed,” said Diana France, RCA director of managed care.

“This collaboration will provide better community access to members that need SUD treatment. Moreover, with Tufts Health Plan's focus on quality, wellness, and behavioral health integration, there are many synergies and this relationship aligns with RCA's treatment goals and objectives.”

France noted that less than a quarter of all patients in need of substance abuse care have access to care.

The partnership is timely as the coronavirus continues to spread. Individuals with a history of substance abuse may be at higher risk to develop severe symptoms for the coronavirus.

Chronic obstructive pulmonary disease (COPD) due to a tobacco addiction, cardiovascular disease due to opioid abuse, and other substance abuse-related respiratory diseases may weaken a patient’s ability to fight the virus, the National Institute of Health noted. Such patients are also more likely to be homeless or incarcerated, putting them at even higher risk.

As a result, payers have been training their focus on providing better substance abuse care and behavioral healthcare during the pandemic.

Some plans made online programs available, such as Blue Cross Blue Shield of Massachusetts’s Learn to Live program. Through Learn to Live, members with a history of substance abuse can access cognitive behavioral therapy online lessons as well as coaches and peer support. The program also serves patients with mental healthcare needs.

Humana in Florida, which recently received recognition for successful member engagement, offered yoga classes to members needing substance abuse care during the crisis. The classes were also available to incarcerated individuals and veterans.

Other payers have been investing in substance abuse care solutions. The Substance Abuse and Mental Health Services Administration (SAMHSA) led the charge in May 2020 by granting $450 million to community-based organizations serving mental and behavioral healthcare needs during the pandemic, including those focused on substance abuse care.

Toward the beginning of the pandemic, Tufts Health Plan also sought to meet member needs by reducing the negative impact of social determinants of health during the public health emergency. The Tufts Health Plan Foundation donated $1 million toward community-based organizations tackling needs like food and housing instability.

As payers continue to navigate the mental and behavioral healthcare fallout of the coronavirus pandemic, better coverage for substance abuse care and mental and behavioral healthcare support continues to be in high demand.