UMass Medical School, MassHealth working to improve treatment rates for those with substance misuse

June 29, 2015

UMass Medical School is working with MassHealth to ensure that its members who struggle with drug and alcohol addiction receive treatment when it is needed.

Substance misuse is on the rise and rates of treatment are relatively low. According to claims data, about 47 percent of MassHealth members with a diagnosed Substance Use Disorder (SUD) seek treatment.

“MassHealth generally fares better than the rest of the country when it comes to initiating and continuing substance misuse treatment. We believe our partnership will help them do even better,” said Jillian Richard-Daniels, MA, MPH, senior project manager in the Center for Health Policy and Research, a unit within UMass Medical School’s Commonwealth Medicine division. “The goal is to make sure MassHealth members get into, and stick with, treatment.”

The MassHealth Initiation and Engagement in Alcohol and Substance Abuse Treatment (IET) Quality Improvement Project aims to increase the rates of people seeking and receiving treatment when needed. The goals of the project are to get people treatment within 14 days of being identified as someone who is misusing alcohol or drugs, and to have two or more visits for treatment within 30 days of treatment being initiated.

The project also aims to identify barriers to treatment for substance misuse and develop interventions that will encourage people to seek help.

The issue of substance misuse is complex. A stigma is still attached to substance misuse and not all providers are comfortable with addressing the problem. To be effective, treatment must address all of the patient’s needs, including medical, psychological, social and legal problems along with the drug or alcohol misuse. 

To help increase rates of treatment in MassHealth members, UMass Medical School and MassHealth partnered with the Central Massachusetts Area Health Education Center (CMAHEC) to develop a free, three-day training for community health workers about substance use disorders. The training emphasized the importance of continued treatment, supporting treatment attempts and follow-up visits.

The training was chosen after a rigorous examination of the rates of treatment. Evaluators working on the project did a root cause analysis to identify potential barriers MassHealth members might experience when seeking treatment, then identified possible interventions given the barriers, time and funding.

In addition to the training, the evaluators published a provider bulletin through MassHealth to educate health care providers about the importance of treatment and follow-up visits, and give them resources to support their efforts in working with patients with substance misuse disorders, Richard-Daniels said.

Community health workers are being increasingly identified as an essential resource in achieving health equity and reducing health disparities as well as preventing and treating such chronic conditions as SUD. According to the 2008 Department of Public Health Community Health Worker Workforce study, about 90 percent of community health workers reported working in some way with patients who misused alcohol or drugs. The training, which ran in two cycles from September to November 2014 and from May to June 2015, focused on teaching community health workers about:

  • The full range of alcohol and other drug treatment options.
  • Local recovery resources and how to use them.
  • Strategies to support recovery attempts and how to feel confident in using those strategies.
  • The SBIRT (screening, brief intervention, and referral to treatment) model and how to use it when applicable.

Trainings were offered in four regions across the state: Boston, Central Massachusetts, Southeastern Massachusetts, and Western Massachusetts. About 120 community health workers participated in the two training cycles.

“I think the training gives community health workers the knowledge they need to be able to support patients and let them know what is available to people with alcohol and drug dependency,” Richard-Daniels said. “We were surprised how quickly they filled up … we had long waiting lists for participation. What was even more interesting is that we received lots of inquiries about the trainings from licensed professionals, including doctors and nurses. I think this just demonstrates the need for more training in this area.”

Some of the health workers attending the training were interested in obtaining more information about opioid and heroin misuse. Others wanted information about the elderly – a population in which substance misuse isn’t always recognized, Richard-Daniels said. 

The MassHealth Initiation and Engagement in Alcohol and Substance Abuse Treatment Quality Improvement Project was financed with a portion of a $1.8 million Adult Medicaid Quality Grant from the Centers for Medicare and Medicaid. Massachusetts is one of 26 states to receive the grant. The two-year grant for the project ended in December, but received a no-cost extension for one year.