Encourage the use of the P-COAT alternative payment model
Recommendation
The Centers for Medicare and Medicaid Services (CMS) should encourage the use of the Patient-centered Opioid Addiction Treatment (P-COAT) alternative payment model, which is designed to improve outcomes and reduce spending for opioid addiction by using three bundled payments: 1) Patient Assessment and Treatment Planning bundle; 2) Initiation of Medication-Assisted Treatment (MAT) bundle; and 3) Maintenance of MAT bundle.[1]
Background/summary
Medications for Opioid Use Disorder (MOUD), particularly when coupled with therapy and support services (collectively often referred to Medication-Assisted Treatment, or MAT) has been effective in treating opioid use disorder (OUD), but cost can be a barrier to accessing treatment.[2][3] Siloed healthcare can also be a barrier for people to obtain the treatment they need. Patients with OUD who are not treated effectively with MAT can add billions of collars in costs to the healthcare system (e.g. increased frequency of emergency department visits and preventable hospital admissions.[4] Medicare is currently the only insurance that offers a bundled payment option for opioid treatment programs (OTP) that helps coordinate and connect care for patients with OUD.[5] The Patient-centered Opioid Addiction Treatment (P-COAT) payment model is designed to improve treatment outcomes with coordinated care, control costs, and ensure appropriate reimbursement rates through bundled payments.[4] There are three bundles, including Patient Assessment and Treatment Planning, Initiation of MAT, and Maintenance of MAT. Each is a payment focused on the different components of OUD treatment covering evaluation and diagnosis, initial outpatient MAT and support services, and ongoing treatment.[6] P-COAT should be used as alternative payment model for OUD treatment to enhance care coordination, improve health outcomes, and lower costs. [1]
citations
1. The Kennedy Forum. Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Last Accessed October 2017.
2. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Medications for Substance Use Disorders. Last Accessed April 25, 2023.
3. National Institutes of Health, National Institute on Drug Abuse. Medications to Treat Opioid Use Disorder Research Report: How much does opioid treatment cost? Last Accessed December 2021.
4. American Society of Addiction Medicine. Patient Centered Opioid Treatment (P-COAT) Alternative Payment Model (APM). Accessed on July 7, 2023.
5. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Opioid Treatment Programs (OTP): Billing and Payment. Last Accessed June 20, 2023.
6. The Kennedy Forum. Payment Reform and Opportunities for Behavioral Health: Alternative Payment Model Examples. Last Accessed September 2017.