Insurers: Addiction Needs Same Urgency As Cancer Care


Addiction is a chronic disease. Why is it not treated as one?

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The nation’s largest insurers signaled a new approach to the opioid crisis that has ravaged families across the country, declaring Wednesday that addiction deserves the same urgency and respect as cancer or diabetes, and should be treated as a chronic disease requiring long-term treatment and monitoring.

Adopting eight “principles of care,” 16 health insurers covering 248 million people said in a statement they would use their purchasing power to reward proven, evidence-based treatments, a step that could improve the quality of care available.

Among those endorsing the commitment were UnitedHealth Group, Aetna, Cigna and WellCare, all national companies, and New Jersey’s largest health insurer, Horizon Blue Cross Blue Shield of New Jersey.

The goal is to “make sure future patients aren’t forced to cycle in and out of treatment, wondering why they don’t work,” said Gary Mendell, a former hotel executive who founded the non-profit Shatterproof after his son died from addiction. Shatterproof hosted the conference call announcement with executives from Cigna and Horizon.


Brian Mendell (right), who died as a direct result of his addiction to drugs on Oct. 20, 2011, with his father, Gary. (Photo: ~Courtesy of Gary Mendell)

Shatterproof convened a national task force earlier this year that included experts and insurance executives.

The core principles the group endorsed were derived from the U.S. Surgeon General’s 2016 report on alcohol, drugs and health. They include routine screening for substance-use disorders in primary care practices, rapid access to addiction treatment, long-term outpatient care and monitoring and coordination of substance-abuse care with other health needs.

“Today, we have evidence-based treatments that save lives, but tragically they are still not widely available,” said Vivek Murthy, former Surgeon General and author of that report.

“Research has proven that addiction is not a character flaw, but a chronic disease of the brain.”

Only one in 10 of the 21 million people across the country who suffer substance-use disorders is in treatment, said Thomas McClellan, former deputy director of the Office of National Drug Control Policy.

And a majority of treatment centers fail to provide the personalized diagnosis, care, and monitoring needed to sustain recovery, he said, “even though science has proven that substance use disorder is a chronic brain disease that can be managed with medical treatment.”

Families who have sought treatment for a loved one say that it can be impossible to find a place in a detox facility in a crisis, and that obtaining appropriate follow-up care and coverage is often a struggle. Treatment options are few and the coverage is limited.

Because of a lack of treatment facilities in various states, South Florida has been dubbed the recovery capital of America. It has sober living facilities, addiction treatment clinics and pristine beaches that help patients addicted to heroin rebuild their lives. People from across America flock to the Sunshine State’s small beach towns for help.

 In Delaware, where there are only 95 inpatient residential treatment beds in the whole state, many who want to get better are forced to seek help out of state at facilities their insurance may or may not cover.

Hundreds of families have been frustrated with an antiquated addiction treatment system that Rita Landgraf, secretary of the state’s Department of Health and Social Services, said lacks the individualized care necessary to treat addiction and prevent relapse.

Delaware’s network has been unable to keep up with the number of addicts, Landgraf said, but DHSS has worked to change that. The state increased the number of residential treatment beds from 78 to 95 in the 2016 fiscal year, which cost the state an additional $800,000.

Horizon, with 3.8 million members in New Jersey, came under pressure from Gov. Chris Christie earlier this year to donate surplus funds for the governor’s addiction-treatment initiatives. Their refusal during budget negotiations led to a state government shutdown.

Opioid addiction is “a public health crisis,” said Mary Ann Christopher, Horizon’s vice president of clinical operations and transformation. The insurer is “trying to get a lot of things on the ground quickly as this crisis escalates,” she said, and adopting a “flexible approach.”

The insurer is making a push to be sure that quality treatment is available in New Jersey, and that patients don’t need to leave the state, she said. “This is a chronic illness and ultimately you have to make that recovery in the place where you live.”

Among the practices the insurer is funding, based on proven success, are peer recovery counselors who visit patients in hospital emergency departments after an overdose reversal and help to get them into treatment. That was based on the success of the program at St. Joseph’s Regional Medical Center in Paterson and Trinitas Regional Medical Center in Elizabeth.

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